原发性骨肉瘤手术患者术中输血相关高危影响因素的分析

Analysis of High-Risk Influencing Factors Related to Intraoperative Blood Transfusion in Patients Undergoing Surgery for Primary Osteosarcoma

目的探讨原发性骨肉瘤手术患者术中输血相关的高危影响因素。方法回顾性分析聊城市中医医院2016年4月—2023年5月收治的108例原发性骨肉瘤手术患者的临床资料。按照术中输血情况分为2组,34例术中输血患者作为输血组,74例术中未输血患者作为未输血组。统计患者在围手术期的输血情况,收集患者的一般资料、术前血常规、凝血资料、临床病理资料以及手术相关资料等,先后采取单因素以及多因素logistic回归分析影响原发性骨肉瘤手术患者术中输血相关的高危影响因素。结果输血组的主要输血成分为悬浮红细胞,输入血浆量200~800 mL,平均(456.21±25.14)mL;输血量1~3U,平均(1.36±0.96)U。输血组与未输血组的年龄、身体质量指数(body mass index,BMI)、术前血红蛋白(hemoglobin,Hb)、术前红细胞比容(hematocrit,Hct)、术前血小板(platelet,PLT)、术前凝血酶原国际化标准比值(international normalizedratio,INR)、术前纤维蛋白原(fibrinogen,FIB)值、病史、术前是否接受化疗、手术方式、手术操作时间、手术分级、麻醉分级比较,差异无统计学意义(P>0.05)。输血组与未输血组的性别、发病部位、Huvos分级、切口长度、重建长度、术中出血量比较,差异有统计学意义(P<0.05)。logistic回归分析结果显示,性别、发病部位、Huvos分级、切口长度、重建长度、术中出血量可作为影响原发性骨肉瘤患者术中出血的高危因素(P<0.05)。结论原发性骨肉瘤患者术中输血率相对较高,针对影响术中输血较高的因素进行可靠的早期干预,并制定准确的术前备血计划,在保证手术安全的前提条件下则能够明显降低术中输血率。

Objective To explore the high-risk influencing factors related to intraoperative blood transfusion in patients undergoing surgery for primary osteosarcoma.Methods The clinical data of 108 patients with primary osteosarcoma treated in Liaocheng Hospital of Traditional Chinese Medicine from April 2016 to May 2023 were retrospectively analyzed.According to the intraoperative blood transfusion,the patients were divided into two groups,34 patients with intraoperative blood transfusion were taken as the transfusion group,and 74 patients without intraoperative blood transfusion were taken as the non-transfusion group.The blood transfusion status of this group of patients during the perioperative was calculated.The general information,preoperative blood routine,coagulation data,clinical and pathological data,as well as surgical related data of patietns were collected,and univariate and multivariate logistic regression analysis was conducted to explore the high-risk factors affecting intraoperative blood transfusion in patients with primary osteosarcoma surgery.Results The main transfusion component of the transfusion group is suspended red blood cells,with an input plasma volume ranging from 200 to 800 mL,an average of(456.21±25.14)mL,a transfusion volume of 1 to 3 U,and an average transfusion volume of(1.36±0.96)U.There were no statistically significant differences in age,body mass index(BMI),preoperative hemoglobin(Hb),preoperative hematocrit(Hct),preoperative platelet(PLT),preoperative prothrombin international normalized ratio(INR),preoperative fibrinogen(FIB)value,medical history,preoperative chemotherapy received,surgical method,surgical operation time,surgical grade,and anesthesia grade between the transfusion group and the non-transfusion group(P>0.05).There were significant differences in gender,site of disease,Huvos grade,incision length,reconstruction length and intraoperative blood loss between the transfusion group and the non-transfusion group(P<0.05).Logistic regression analysis showed that gender,site of disease,Huvos grade,incision length,reconstruction length,and intraoperative blood loss could be considered as risk factors for intraoperative bleeding in patients with primary osteosarcoma(P<0.05).Conclusion The intraoperative blood transfusion rate of patients with primary osteosarcoma is relatively high.Reliable early intervention and accurate preoperative blood preparation plan for the factors affecting the high intraoperative blood transfusion can significantly reduce the intraoperative blood transfusion rate on the premise of ensuring surgical safety.