非体外循环冠状动脉旁路移植术患者术中出血和输血的危险因素

Risk factors for intraoperative hemorrhage and transfusion in patients undergoing off-pump coronary artery bypass grafting

目的筛选非体外循环冠状动脉旁路移植术(OPCABG)患者术中出血和输血的危险因素。方法选取2021年6月7日至2023年3月8日行OPCABG患者1442例,ASA分级≥Ⅱ级,性别不限,年龄≥18岁。记录患者一般资料、术前血流动力学、术前血常规、手术时间、移植血管根数、术中血管活性药物应用情况、术中晶体液和胶体液用量、尿量、血制品、氨甲环酸和乌司他丁应用情况。采用单因素和多重线性回归筛选术中出血量及浓缩红细胞(CRBC)输注量的危险因素,采用单因素和多因素logistic回归模型筛选术中CRBC输注需求的危险因素。结果共1420例患者纳入统计分析。手术时间延长、移植血管数量增多和年龄增长是OPCABG患者术中出血量的危险因素,男性、术中新鲜冰冻血浆用量增多、尿量增多、应用乌司他丁和氨甲环酸是术中出血量的保护因素(P<0.05)。手术时间延长和术中新鲜冰冻血浆用量增多是OPCABG患者术中CRBC输注量的危险因素,术前Hb水平升高是术中CRBC输注量的保护因素(P<0.05)。手术时间延长和术中新鲜冰冻血浆用量增多是术中CRBC输注需求的危险因素,BMI增大、术前Hb水平升高和应用乌司他丁是术中CRBC输注需求的保护因素(P<0.05)。结论手术时间延长、移植血管数量增多、年龄增长是OPCABG患者术中出血量的危险因素,男性、术中新鲜冰冻血浆用量和尿量增多、应用乌司他丁和氨甲环酸是术中出血量的保护因素。手术时间延长和术中新鲜冰冻血浆用量增多是OPCABG患者术中CRBC输注需求和输注量的危险因素,术前Hb水平升高是术中CRBC输注量的保护因素,BMI增大、术前Hb水平升高和术中应用乌司他丁是术中CRBC输注需求的保护因素。

Objective To identify the risk factors for intraoperative hemorrhage and transfusion in patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods A total of 1,442 patients,regardless of gender,of American Society of Anesthesiologists Physical Status classification≥Ⅱ,scheduled for elective OPCABG from June 7,2021 to March 8,2023,were enrolled in a prospective,observational study.Patients′general characteristics,preoperative hemodynamics,preoperative blood routine,duration of operation,the number of transplanted vessels,intraoperative application of vasoactive agents,intraoperative consumption of crystalloid and colloid,urine volume,blood products,use of tranatemic acid and ulinastatin were collected.Univariable and multiple linear regression models were used to screen the risk factors for intraoperative blood loss and infusion volume of concentrated red blood cell(CRBC),and univariable and multivariable logistic regression models were used to screen the risk factors for intraoperative CRBC infusion requirement.Results One thousand four hundred and twenty patients were finally included.Prolonged operation duration,increased number of transplanted vessels and older age were risk factors for intraoperative blood loss,while male,increased intraoperative usage of fresh frozen plasma(FFP),increased urine volume,and application of ulinastatin and tranexamic acid were protective factors for intraoperative blood loss in OPCABG patients(P<0.05).Prolonged operation duration and increased intraoperative usage of FFP were risk factors for intraoperative CRBC transfusion volume,while elevation of preoperative hemoglobin levels was a protective factor for intraoperative CRBC transfusion volume in OPCABG patients(P<0.05).Prolonged operation duration and increased intraoperative usage of FFP were risk factors for intraoperative CRBC infusion requirement,while increased body mass index,elevation of preoperative hemoglobin levels and application of ulinastatin were protective factors for CRBC infusion requirement(P<0.05).Conclusions Prolonged operation duration,increased number of transplanted vessels and older age are risk factors for intraoperative blood loss,and increased intraoperative usage of FFP,increased urine volume,and application of ulinastatin and tranexamic acid are protective factors for intraoperative blood loss in OPCABG patients.Prolonged operation duration and increased intraoperative usage of FFP are risk factors for intraoperative CRBC infusion requirement and transfusion volume,elevation of preoperative hemoglobin levels is a protective factor for intraoperative CRBC infusion volume,and increased body mass index,elevation of preoperative hemoglobin levels and intraoperative application of ulinastatin are protective factors for intraoperative CRBC infusion requirement in patients undergoing OPCABG.