肝细胞癌肝切除术患者术中大出血的术前危险因素探究

Pre-operative risk factors of intraoperative massive bleeding during liver resection for hepatocellular carcinoma

目的探讨肝细胞癌肝切除术中发生大出血的术前危险因素,并针对危险因素提出术中护理对策。方法将肝细胞癌行肝切除术患者1 051例,根据术中出血量分为术中大出血组(n=170)和非大出血组(n=881)。对两组变量进行单因素分析和多因素Logistic回归分析。结果 Logistic多元回归分析发现术前血小板<100×10~9/L(OR=1.731)、肿瘤直径>5.0 cm(OR=2.454)、合并门静脉血栓(OR=1.492)和大块肝切除术(OR=1.577)是肝细胞癌肝切除术患者术中大出血的术前危险因素(P<0.05,P<0.01)。大出血组术中输注红细胞悬液、新鲜冰冻血浆、晶体的量显著高于非大出血组,手术结束时的体温显著低于非大出血组,手术时间显著长于非大出血组(均P<0.01)。结论护理人员需充分了解肝细胞癌肝切除术患者术中大出血的术前危险因素,加强相应的术前、术中护理干预,减少术中出血。

Objective To evaluate the risk factors associated with massive bleeding during liver resection for hepatocellular carcinoma(HCC)and propose intraoperative nursing management.Methods A total of 1051 HCC patients undergoing liver resection were reviewed retrospectively.They were allocated into the massive bleeding group(n=170)and the non-massive bleeding group(n=881)according to intraoperative bleeding volume.Risk factors associated with massive bleeding during hepatectomy was identified by logistic regression analysis.Results Logistic multivariate analysis revealed that preoperative platelet count<100×10~9/L(OR=1.731),tumor diameter>5.0 cm(OR=2.454),portal vein tumor thrombus formation(OR=1.492)and major hepatectomy(OR=1.577)were the major risk factors linked to intraoperative massive bleeding(P<0.05,P<0.01).The transfusion volume of red blood cell,fresh frozen plasma,crystal fluid in the massive bleeding group was significantly larger than those in the non-massive bleeding group(P<0.01 for all).Body temperature at the end of surgery was significantly lower,and duration of surgery was significantly longer in the massive bleeding group than the non-massive bleeding group(P<0.01).Conclusion In order to mi-nimize intraoperative blood loss,nurses need to fully understand the risk factors of massive bleeding during liver resection for HCC,reinforce pre-operative and intraoperative interventions,and take measures to avoid hypothermia.