■考虑到腹膜后肉瘤(RPS)手术期间大出血的高风险,严重的并发症和死亡是常见的围手术期。因此,有效的麻醉管理是保证患者安全的关键。本研究旨在介绍手术期间接受大量输血的RPS患者的麻醉管理和死亡率。
■从我们的数据库中回顾性检索了2016年1月至2021年12月全身麻醉下RPS手术的记录。最终将在24小时内接受超过20单位的大量输血(MBT)的患者纳入本研究。人口统计,麻醉管理方式,失血,输血,收集围麻醉生化检查以及发病率和死亡率。采用统计学软件STATA17.0进行单因素和多因素分析,确定术后60d死亡的危险因素。
■共纳入70例患者(男性31例)。平均年龄为50.1±15.8岁。所有患者均在全身麻醉下接受了累及器官的肉瘤联合切除。平均手术时间和麻醉时间分别为491.7±131.1分钟和553.9±132.6分钟,分别。术中出血量中位数为7000ml(IQR5500,10000ml)。红细胞(RBC)和新鲜冰冻血浆(FFP)的中位数为25.3u(IQR20,28u),和2400ml(IQR2000,3000ml),分别。其他血液制品输注包括凝血酶原复合物浓缩物(PCCs),纤维蛋白原浓缩物(FC),血小板(plt)和白蛋白(alb)占82.9%(58/70),88.6%(62/70),81.4%(57/70)和12.9%(9/70)的患者。术后严重并发症发生率(Clavien-Dindo分级≥3a)为35.7%(25/70)。在术后60天期间,共有7名患者(10%)死亡。BMI,麻醉中的晶体输注量,单因素分析发现手术终止时的血红蛋白和乳酸水平与术后死亡发生显著相关。在逻辑多变量分析中,麻醉时间延长与术后静脉血栓栓塞(VTE)和严重并发症相关.术后即刻乳酸水平是影响围手术期死亡的唯一危险因素(p<0.05)。
■在手术中忍受MBT的RPS患者术后面临更高的死亡风险,这需要在高容量RPS中心进行精确有效的麻醉管理。血乳酸水平升高可能是术后死亡的预测因素,应注意。
UNASSIGNED: Given high risks of major bleeding during retroperitoneal sarcoma(RPS) surgeries, severe complications and deaths are common to see perioperatively. Thus, effective anesthetic management is the key point to ensuring the safety of patients. This study aimed to introduce anesthesia management and mortalities in RPS patients receiving massive blood transfusions during surgeries.
UNASSIGNED: Records of RPS surgeries under general anesthesia from January 2016 through December 2021 were retrospectively retrieved from our database. Patients who received massive blood transfusions (MBT) exceeding 20 units in 24h duration of operations were finally included in this study. Demographics, modalities of anesthesia management, blood loss, transfusion, peri-anesthesia biochemical tests as well as morbidities and mortalities were collected. Risk factors of postoperative 60d mortality were determined through logistic regression in uni-and multi-variety analysis using the statistics software STATA 17.0.
UNASSIGNED: A total of 70 patients (male 31) were included. The mean age was 50.1 ± 15.8 years. All patients received combined resections of sarcoma with involved organs under general anesthesia. Mean operation time and anesthesia time were 491.7 ± 131.1mins and 553.9 ± 132.6mins, respectively. The median intraoperative blood loss was 7000ml (IQR 5500,10000ml). Median red blood cells (RBC) and fresh frozen plasma (FFP) transfusion were 25.3u (IQR 20,28u), and 2400ml (IQR 2000,3000ml), respectively. Other blood products infusions included prothrombin complex concentrate (PCCs), fibrinogen concentrate (FC), platelet(plt) and albumin(alb) in 82.9% (58/70), 88.6% (62/70), 81.4% (57/70) and 12.9% (9/70) of patients. The postoperative severe complication rate(Clavien-Dindo grade≥3a) was 35.7%(25/70). A total of 7 patients (10%) died during the postoperative 60-day period. BMI, volumes of crystalloid infusion in anesthesia, and hemoglobin and lactate levels at the termination of operation were found significantly associated with postoperative occurrence of death in univariate analysis. In logistic multivariate analysis, extended anesthesia duration was found associated with postoperative venous thrombosis embolism (VTE) and severe complication. The lactate level at the immediate termination of the operation was the only risk factor related to perioperative death (p<0.05).
UNASSIGNED: RPS patients who endure MBT in surgeries face higher risks of death postoperatively, which needs precise and effective anesthesia management in high-volume RPS centers. Increased blood lactate levels might be predictors of postoperative deaths which should be noted.