外科手术患者红细胞输注有效率的影响因素

Influencing Factors of Red Blood Cell Transfusion Efficiency in Surgical Patients

目的探讨外科手术患者红细胞输注有效率的影响因素,为临床提高红细胞输注有效率提供参考依据。方法选取驻马店市中心医院2020年1月至2022年12月接受红细胞输注的外科手术患者162例,统计红细胞输注有效率,收集临床资料,采用Lasso-logistic回归分析外科手术患者红细胞输注有效率的影响因素。结果162例接受红细胞输注的外科手术患者中,红细胞输注有效130例(80.25%)、无效32例(19.75%)。无效患者中女性、既往输血史、自身免疫性疾病史、恶性肿瘤史、感染、肝脾肿大、贫血史占比高于有效患者(P<0.05)。无效患者红细胞保存天数、输血前白细胞计数、中性粒细胞百分比高于有效患者,无效患者输血前血红蛋白、红细胞压积低于有效患者(P<0.05)。无效患者的血浆与红细胞占比与有效患者比较,差异有统计学意义(P<0.05)。Lasso回归分析筛选出10个因素:既往输血史、自身免疫性疾病史、恶性肿瘤史、感染、贫血史、红细胞保存天数、血浆与红细胞比例、输血前血红蛋白、红细胞压积、白细胞计数,经logistic回归分析,以上10个因素均为外科手术患者红细胞输注有效率的独立影响因素(P<0.05)。据此构建外科手术患者红细胞输注有效率的预测模型,校正曲线显示,该预测模型的校准度为0.827,一致性指数为0.809,ROC曲线显示,该预测模型预测外科手术患者红细胞输注有效率的AUC为0.918。结论根据既往输血史、自身免疫性疾病史、恶性肿瘤史、感染、贫血史、红细胞保存天数、血浆与红细胞比例、输血前血红蛋白、红细胞压积、白细胞计数等影响因素构建外科手术患者红细胞输注有效率预测模型具有可靠的预测价值,能为临床提供指导信息。

Objective To explore the factors affecting the effective rate of red blood cell transfusion in surgical patients,and to provide reference for improving the effective rate of red blood cell transfusion in clinic.Methods A total of 162 surgical patients who received red blood cell transfusion in Zhumadian Central Hospital from January 2020 to December 2022 were selected.The effective rate of red blood cell transfusion was calculated,clinical data were collected,and the influencing factors of red blood cell transfusion efficiency in surgical patients were analyzed by Lasso-logistic regression.Results Among 162 surgical patients who received red blood cell transfusion,130 cases(80.25%)were effective and 32 cases(19.75%)were ineffective.The proportion of ineffective patients who were female,had a history of previous blood transfusions,autoimmune diseases,malignant tumors,infections,hepatosplenomegaly,and anemia was higher than that of effective patients(P<0.05).Invalid patients had higher red blood cell retention days,pre transfusion white blood cell count,and neutrophil percentage than effective patients,while ineffective patients had lower hemoglobin and hematocrit before transfusion than effective patients(P<0.05).The proportion of plasma and red blood cells in ineffective patients was significantly different from that in effective patients(P<0.05).Lasso regression analysis identified 10 factors:history of previous blood transfusions,history of autoimmune diseases,history of malignant tumors,infection,anemia history,red blood cell preservation days,plasma to red blood cell ratio,pre transfusion hemoglobin,hematocrit,and white blood cell count.Logistic regression analysis showed that all 10 factors were independent influencing factors on the effectiveness of red blood cell transfusion in surgical patients(P<0.05).Based on this,a prediction model for the effectiveness of red blood cell transfusion in surgical patients was constructed.The calibration curve showed that the calibration degree of the prediction model was 0.827,and the consistency index was 0.809.The ROC curve showed that the AUC of the prediction model for the effectiveness of red blood cell transfusion in surgical patients was 0.918.Conclusion Constructing a predictive model for the effectiveness of red blood cell transfusion in surgical patients based on factors such as past transfusion history,autoimmune disease history,malignant tumor history,infection,anemia history,red blood cell preservation days,plasma to red blood cell ratio,pre transfusion hemoglobin,hematocrit,white blood cell count,etc.has reliable predictive value and can provide guidance information for clinical practice.