A型主动脉夹层患者围术期大量输血的术前危险因素分析

Preoperative risk factors of perioperative massive blood transfusion in patients with type A aortic dissection

目的分析A型主动脉夹层患者围术期大量输血的术前危险因素。方法回顾性分析该院2021年1月至2022年7月收治的61例A型主动脉夹层成人手术患者临床资料(基本资料、基础病史、术前用药情况)、术前相关实验室检查(血常规、凝血5项、肝功能、肾功能、快速血栓弹力图)和术中、术后24 h内血液制品种类及用量等指标。根据术中或术后24 h红细胞输注量将患者分为大量输血组和非大量输血组,对两组患者的临床资料和术前相关实验室检查进行单因素分析,最后对经过单因素分析有统计学意义的变量做多因素logistic回归分析。结果单因素分析发现两组患者之间的年龄、血红蛋白(Hb)、是否使用抗凝药物、凝血酶原时间(PT)、天门冬氨酸氨基转移酶(AST)、MA值的差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示两组间Hb、MA值的差异有统计学意义(P<0.05),且Hb和MA值越低,A型主动脉夹层围术期大量输血的概率越高。结论Hb和MA值降低是A型主动脉夹层围术期大量输血的术前危险因素。

Objective To analyze the preoperative risk factors of perioperative massive blood transfusion in patients with type A aortic dissection.Methods The clinical data(basic data,basic medical history,preoperative medication),preoperative laboratory tests [blood routine,five items of bloodcoagulation,liver and kidney function,rapid thromboelastography(r-TEG)] and the dosage of blood products within 24 hours after operation of 61 adult patients with type A aortic dissection admitted to Chongqing Emergency Medical Center from January 2021 to July 2022 were collected.The patients were divided into two groups according to the intraoperative or postoperative 24-hour red blood cell transfusion volume.The clinical data and preoperative laboratory tests of the two groups were analyzed by univariate analysis,and finally multivariate logistic regression analysis was carried out for the variables that were significant after univariate analysis.Results Univariate analysis showed that there were significant differences in age,hemoglobin(Hb),anticoagulant use,prothrombin time(PT),aspartate aminotransferase(AST) and MA between the two groups(P<0.05).Multivariate logistic regression analysis showed that there were significant differences in Hb and MA between the two groups(P<0.05),and the lower the Hb and MA values,the higher the probability of perioperative massive blood transfusion in type A aortic dissection.Conclusion The decrease of Hb and MA values are preoperative risk factor of perioperative massive blood transfusion for type A aortic dissection.