摘要
目的通过分析肺移植患者围术期的基础资料、手术情况、实验室检查以及术中输血情况,探讨造成肺移植术中异体血液制剂输注的危险因素及预后影响,从而最终指导临床用血。方法回顾性分析2022年1月—2023年12月在本院接受肺移植手术的319例患者的资料,根据术中输血情况分成非输血组(70例)和输血组(249例),比较2组患者的临床资料、手术情况、围术期实验室术前及术后相关指标的统计学差异,分析术后预后(好转、未愈及死亡)情况。结果2组患者经比较后,发现非输血组术前Hb(g/L)(144.41±17.66 vs 129.78±20.44)、术前Hct[43.25(40.23,47.5)vs 40.7(37,43.55)]、术前TBIL(μmol/L)[11.45(9.15,15.3)vs 9.9(6.88,13.33)]、术后PLT(×10^(9)/L)[(167.74±64.43 vs 132.37±54.84)]水平大于输血组,P值均<0.05;非输血组术前pCO_(2)(mmHg)[41.4(37.4,45.8)vs 45.3(40,52.48)]、术后TBIL(μmol/L)[25.45(17.68,33.95)vs 30.8(21.55,43.05)]、术后pH(7.41±0.09 vs 7.45±0.10)、双肺移植(例)[27(38.6%)vs 157(63.1%)]、手术时长(h)[5(4,7)vs 6.5(5,8)]、使用ECMO(例)[52(74.3%)vs 232(93.2%)]、术中出血量(mL)[600(500,800)vs 1000(800,1500)]水平小于输血组,P值均<0.05,差异具有统计学意义。将比较指标中P<0.1的项目纳入二元Logistic回归分析,结果表明双肺移植、术中出血量、术前TBIL、术后PLT、术后TBIL、术前pCO_(2)及术后pH与是否输血呈显著关联(P<0.05)。非输血组和输血组术后好转及死亡人数的χ^(2)检验P值均>0.05,故2组患者预后率之间无统计学差异。结论双肺移植、术中出血量、术前TBIL、术前pCO_(2)是肺移植术中输血的危险因素,且术中输血对术后PLT、术后TBIL、术后pH指标有显著影响,但对预后无明显影响。充分评估各项实验室指标及手术情况有助于临床更有效地制定输血策略。
Objective To explore the risk factors of allogeneic blood transfusion during lung transplant surgery and prognostic effects of transfusion by analyzing the basic data,surgical details,laboratory tests results,and intraoperative blood transfusion details during the perioperative period of lung transplant,so as to guide clinical blood use.Methods A retrospective analysis was conducted on the data of 319 patients who underwent lung transplantation surgery in our hospital from January 2022 to December 2023.The patients were divided into a non-transfusion group(n=70)and a transfusion group(n=249)based on their intraoperative blood transfusion status.The clinical data,surgical details,perioperative laboratory results and other relevant preoperative and postoperative parameters were compared between the two groups,and the postoperative prognosis(improvement,non-recovery,and death)was analyzed.Results After comparison between the two groups of patients,it was found that the non-transfusion group had higher levels of preoperative Hb(g/L)(144.41±17.66 vs 129.78±20.44),preoperative Hct[43.25(40.23,47.5)vs 40.7(37,43.55)],preoperative TBIL(μmol/L)[11.45(9.15,15.3)vs 9.9(6.88,13.33)],and postoperative PLT(×10^(9)/L)(167.74±64.43 vs 132.37±54.84)than the transfusion group(all P<0.05).The non-transfusion group had lower levels of preoperative pCO_(2)(mmHg)[41.4(37.4,45.8)vs 45.3(40,52.48)],postoperative TBIL(μmol/L)[25.45(17.68,33.95)vs 30.8(21.55,43.05)],postoperative pH(7.41±0.09 vs 7.45±0.10),bilateral lung transplantation[27(38.6%)vs 157(63.1%)],surgical duration(h)[5(4,7)vs 6.5(5,8)],use of ECMO[52(74.3%)vs 232(93.2%)],and intraoperative blood loss(mL)[600(500,800)vs 1000(800,1500)]compared to the transfusion group(all P<0.05).The items with P<0.1 in the compared indicators were included in the binary logistic regression analysis,and the results showed that bilateral lung transplantation,intraoperative blood loss,preoperative TBIL,postoperative PLT,postoperative TBIL,preoperative pCO_(2),and postoperative pH were significantly correlated with whether blood transfusion was performed(P<0.05).The P values of the Chi-square test for postoperative improvement and mortality in the non transfusion group and transfusion group were both greater than 0.05,indicating no statistically significant difference in the prognosis rate between the two groups of patients.Conclusion Bilateral lung transplantation,intraoperative blood loss,preoperative TBIL,and preoperative pCO_(2) are risk factors for blood transfusion during lung transplantation.Intraoperative blood transfusion has a significant impact on postoperative PLT,postoperative TBIL,and postoperative pH indicators,but has no significant effect on prognosis.A comprehensive evaluation of laboratory indicators and surgical details can help developing blood transfusion strategies more effectively.
作者
杨华莹
强新晨
孙玲玲
邵俊良
YANG Huaying;QIANG Xinchen;SUN Lingling;SHAO Junliang(Department of Blood Transfusion,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,China)
出处
《中国输血杂志》
2025年第6期772-776,共5页
Chinese Journal of Blood Transfusion
基金
江苏省输血协会英科新创科研基金资助项目(JSYK2023014)。
关键词
术中输血
肺移植
预后
intraoperative blood transfusion
lung transplantation
prognosis
作者简介
第一作者:杨华莹(1991-),女,主管技师,Email:yingyingshj@126.com;通信作者:邵俊良,Email:shaojl@wuxiph.com。
