河北省心血管外科围手术期用血现状的多中心回顾性研究

A Multicenter Retrospective Study of Perioperative Blood Use in Cardiovascular Surgery in Hebei Province

目的分析心血管外科围手术期用血现状及异体输血的影响因素,为围手术期血液管理提供参考。方法选取2019年-2020年河北省102家医院共772例主动脉瓣置换术(AVR)和冠状动脉旁路移植术(CABG)患者的临床资料,比较围手术期关键指标、不同血液成分、不同等级医院输血率和输血量的差异,并采用多元线性逐步回归模型分析围手术期异体输血的影响因素。结果2019年-2020年,河北省医院AVR患者异体输血率分别为93.3%和100.0%,CABG患者异体输血率分别为89.4%和90.2%,异体输血率普遍较高。输血概率与医院等级相关,围手术期出血量、手术时长等是影响输血总需求的主要风险因素。结论河北省各医院应建立多学科协同血液管理模式,实施患者血液管理策略,积极推进自体输血技术应用,改良手术方式;相关管理部门应开展临床用血评价与公示,促进各医院严格落实临床用血审核制度,为患者制订合理、科学的输血方案,以降低出血量和异体输血率,进而保障输血安全。

Objective To analyze the current situation of perioperative blood use in cardiovascular surgery and the influencing factors of allogeneic transfusion,and to provide reference for perioperative blood management.Methods The clinical data of 772 patients undergoing aortic valve replacement(AVR)and coronary artery bypass graft(CABG)from 102 hospitals in Hebei Province from 2019 to 2020 were selected to compare the perioperative key indicators,different blood components,blood transfusion rate and blood transfusion volume of different hospital grades.Multiple linear stepwise regression model was used to analyze the influencing factors of perioperative allogeneic blood transfusion.Results From 2019 to 2020,the rates of allogeneic transfusion in AVR patients and CABG patients were 93.3%and 100.0%,respectively,and 89.4%and 90.2%,respectively.The rates of allogeneic transfusion were generally high.The probability of transfusion was related to hospital grade.Perioperative blood loss and operation duration were the main risk factors affecting the total transfusion demand.Conclusion All hospitals in Hebei Province should establish a multidisciplinary collaborative blood management mode,implement the strategy of patient blood management,and actively promote the application of autologous transfusion technology to improve surgical methods.Relevant management departments should carry out clinical blood evaluation and publicity,promote hospitals to strictly implement clinical blood review,and formulate reasonable and scientific blood transfusion programs for patients,so as to reduce the amount of blood loss and the rate of allogeneic blood transfusion,and thus ensure the safety of blood transfusion.