脊柱矫形手术单病种围术期异体成分血输注的纵向观察研究

Perioperative allogenic blood transfusion for single disease in patients undergoing spinal deformity correction surgery:a longitudinal observational study

目的分析脊柱矫形手术单病种围术期临床用血概况及异体成分血输注的影响因素,为临床制定输血决策提供参考。方法回顾性分析2015年1月—2017年12月于成都市第三人民医院择期行脊柱矫形手术的292例患者病案首页资料,依据单病种类别对异体成分血的输注概况进行统计学分析,多因素线性回归分析脊柱矫形手术异体成分血围术期输注的危险因素,并将纳入患者分输血组与未输血组采用Mann-Whitney U检验与χ^(2)检验分析异体成分血输注对住院时间和出院情况的影响。结果2015—2017年,围术期异体成分血输注率依次为90.38%(47/52)、93.62%(44/47)、81.35%(157/193);强直性脊柱炎后凸畸行,脊柱后侧凸,青少年特发性脊柱侧弯、脊柱侧弯和椎管狭窄患者异体成分血输注率依次为89.08%(106/119)、79.49%(62/78)、95.24%(40/42)、84.38%(27/32)和61.90%(13/21);多因素线性回归分析显示年龄与截骨术的回归系数值分别为-0.060(t=-2.281,P=0.023)和2.060(t=4.468,P=0.000);与围术期未输注异体成分血相比较,输血组住院时间更长(P<0.05)。结论脊柱矫形手术异体成分血输注与单病种类别密切相关,年龄是围术期异体成分血输注的保护因素,而截骨术是围术期异体成分血输注的危险因素;围术期输血也会延长患者的住院时间。

Objective To analyze the profile of perioperative allogenic blood transfusion for single disease in patients who underwent spinal deformity correction surgery and risk factors of the blood transfusion,in order to provide reference for clinical decision making.Methods Clinical data from medical record homepage of 292 patients who underwent elective spinal deformity correction surgery at Chengdu Third People′s Hospital from January 2015 to December 2017 were retrospectively analyzed.Statistical analysis of the transfusion profile of allogeneic blood based on the type of single disease in patients undergoing correction surgery was performed.Multiple factor linear regression analysis was used to identify the risk factors of perioperative allogenic blood transfusion in patients with spinal deformity correction surgery.Hospital length of stay and discharge status were compared between transfusion group and non-transfusion group using Mann Whitney U test and chi-square test respectively.Results The year prevalence of perioperative allogeneic blood transfusion from 2015 to 2017 were 90.38%(47/52),93.62%(44/47)and 81.35%(157/193),respectively.The prevalence of perioperative allogeneic blood transfusion in patients with kyphotic deformity in ankylosing spondylitis,kyphosis,adolescent idiopathic scoliosis,scoliosis and spinal stenosis were 89.08%(106/119)、79.49%(62/78)、95.24%(40/42)、84.38%(27/32)and 61.90%(13/21),respectively.Multivariate linear regression analysis showed that the regression coefficients for age and osteotomy were-0.060(P<0.05)and 2.060(P<0.05),respectively.Compared with non-transfusion group,the transfusion group had longer hospital length of stay(P<0.05).Conclusion Perioperative allogeneic blood transfusion in patients with spinal deformity correction surgery is closely related to the type of single disease.Age is a protective factor for perioperative allogeneic blood transfusion,while osteotomy is a risk factor for perioperative allogeneic blood transfusion in patients undergoing the spinal deformity correction surgery.Perioperative blood transfusion can also prolong the hospital length of stay of the patients.