目的:输血是先天性心脏手术(CHS)中常见的挽救生命的手术,患者在手术前确定危险因素至关重要。我们的目的是分析CHS期间影响血液使用的术前因素,并为术前血液准备提供指导。
方法:对我院2019年5月至2020年6月共1550例病例进行回顾性分析。我们确定是否使用红细胞(RBC),血小板,和血浆作为因变量;我们将特征和实验室测试的数据视为二进制数据,除了先天性心脏手术风险调整(RACHS)方法作为多项数据,最后进行二元Logistic回归分析。
结果:输注红细胞的总量,血小板,血浆为850.5U(N=713,46%),159U(N=21,1.4%),和1374.2U(N=953,61.5%),分别。多因素分析发现年龄(OR0.142,95%CI0.099-0.203,P<0.001),重量(0.170,0.111-0.262,P<0.001)RACHS方法(RACHS2与RACHS1,3.444,2.521-4.704,P<0.001;RACHS3vs.RACHS1,9.333,4.731-18.412,P<0.001;RACHS4vs.RACHS1,31.327,2.916-336.546,P=0.004),和血红蛋白(0.524,0.315-0.871,P=0.013)是红细胞输注量的独立风险预测因子;年龄(9.911,1.008-97.417,P=0.049),重量(0.029,0.003-0.300,P=0.029),RACHS方法(RACHS3与RACHS1,13.001,2.482-68.112,P=0.002;RACHS4与RACHS1,59.748,6.351-562.115,P<0.001)是血小板;年龄(0.488,0.352-0.676,P<0.001),体重(0.252,0.164-0.386,P<0.001),RACHS方法(RACHS2与RACHS1,2.931,2.283-3.764,P<0.001;RACHS3vs.RACHS1,10.754,4.751-24.342,P<0.001),APTT(1.628,1.058-2.503,P=0.027),PT(2.174,1.065-4.435,P=0.033)为血浆。
结论:尽管患者年龄,体重,血常规检查,凝血功能,和蛋白质水平都应该考虑在CHS之前准备血液,RACHS方法是影响术中输血量的最重要因素,应在临床血液准备中首先考虑。
OBJECTIVE: Blood transfusion is a common and life-saving procedure in congenital heart surgery (CHS), and it is critical for patients to identify risk factors prior to surgery. Our objective is to conduct an analysis of the preoperative factors that influence blood use during CHS and to offer guidance on preoperative blood preparation.
METHODS: A total of 1550 cases were retrospectively analyzed in our institution between May 2019 and June 2020. We determined whether to employ red blood cells (RBCs), platelets, and plasma as dependent variables; we treated the data from characteristics and laboratory tests as binary data, except for the Risk Adjustment for Congenital Heart Surgery (RACHS) methods as multinomial data, and finally taken into binary logistic regression analysis.
RESULTS: The total amounts of transfused RBCs, platelets, and plasma were 850.5 U (N = 713, 46%), 159 U (N = 21, 1.4%), and 1374.2 U (N = 953, 61.5%), respectively. Multivariate analysis found age (OR 0.142, 95% CI 0.099-0.203, P < 0.001), weight (0.170, 0.111-0.262, P < 0.001) RACHS method (RACHS2 vs. RACHS1, 3.444, 2.521-4.704, P < 0.001; RACHS3 vs. RACHS1, 9.333, 4.731-18.412, P < 0.001; RACHS4 vs. RACHS1, 31.327, 2.916-336.546, P = 0.004), and hemoglobin (0.524, 0.315-0.871, P = 0.013) to be independent risk predictors of RBC transfused volume; age (9.911, 1.008-97.417, P = 0.049), weight (0.029, 0.003-0.300, P = 0.029), RACHS method (RACHS3 vs. RACHS1, 13.001, 2.482-68.112, P = 0.002; RACHS4 vs. RACHS1, 59.748, 6.351-562.115, P < 0.001) to be platelets; and age (0.488, 0.352-0.676, P < 0.001), weight (0.252, 0.164-0.386, P < 0.001), RACHS method (RACHS2 vs. RACHS1, 2.931, 2.283-3.764, P < 0.001; RACHS3 vs. RACHS1, 10.754, 4.751-24.342, P < 0.001), APTT (1.628, 1.058-2.503, P = 0.027), and PT (2.174, 1.065-4.435, P = 0.033) to be plasma.
CONCLUSIONS: Although patients\' age, weight, routine blood test, coagulation function, and protein levels should all be considered for preparing blood before CHS, the RACHS method is the most important factor influencing intraoperative blood transfused volume and should be considered first in clinical blood preparation.