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姜蕾, 刘希曦, 王琪, 王璐璐, 曹永彤. 肺移植患者术中输血的关联因素分析及输血对患者预后的影响[J]. 解放军医学院学报, 2021, 42(10): 1040-1044. DOI: 10.3969/j.issn.2095-5227.2021.10.007
引用本文: 姜蕾, 刘希曦, 王琪, 王璐璐, 曹永彤. 肺移植患者术中输血的关联因素分析及输血对患者预后的影响[J]. 解放军医学院学报, 2021, 42(10): 1040-1044. DOI: 10.3969/j.issn.2095-5227.2021.10.007
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JIANG Lei, LIU Xixi, WANG Qi, WANG Lulu, CAO Yongtong. Factors associated with intraoperative blood transfusion in lung transplantation and their impacts on prognosis[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2021, 42(10): 1040-1044. DOI: 10.3969/j.issn.2095-5227.2021.10.007
Citation: JIANG Lei, LIU Xixi, WANG Qi, WANG Lulu, CAO Yongtong. Factors associated with intraoperative blood transfusion in lung transplantation and their impacts on prognosis[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2021, 42(10): 1040-1044. DOI: 10.3969/j.issn.2095-5227.2021.10.007
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肺移植患者术中输血的关联因素分析及输血对患者预后的影响

Factors associated with intraoperative blood transfusion in lung transplantation and their impacts on prognosis

    摘要
  • 摘要:
      背景  输血是肺移植手术重要治疗措施之一，其发生率受多因素影响。输血量过多可能影响肺移植手术预后。
      目的  探讨肺移植术中输血的危险因素及其对肺移植患者预后的影响。
      方法  回顾性分析2017年3月- 2019年6月本院194例肺移植病例，根据术中输血情况将肺移植受者分为输血组(65例)和非输血组(129例)，对两组肺移植受者的临床资料以及术中输血的危险因素及预后情况进行分析。
      结果  194例受者总输血率为33.5%。与非输血组相比，输血组术前血红蛋白低，术前国际标准化比值(international normalized ratio，INR)高，术前抗凝治疗、术中胸腔粘连占比高，手术时间长(P均＜0.05)。输血组受者的总生存低于非输血组(P＜0.05)。Logistic回归显示，术前抗凝治疗(OR=4.551，P=0.006)、术前INR高(OR=2.964，P=0.004)、术中胸腔粘连(OR=4.560，P=0.000)、术前血红蛋白低(OR=0.462，P=0.045)及手术时间长(OR=6.106，P=0.000)与输血有显著关联。输血组原发性移植物功能障碍(primary graft dysfunction，PGD) 3级的发生率(26.2% vs 10.9%，P=0.01)和术后30 d内死亡率(32.3% vs 14.7%，P＜0.01)均高于非输血组。
      结论  术前抗凝治疗、术前血红蛋白低、术前INR高、术中胸腔粘连和手术时间长是肺移植术中输血的危险因素，输血者预后较未输血者差。

     

    Abstract:
      Background  Blood transfusion is one of the important treatment measures in lung transplantation, and its incidence is affected by many factors. Excessive blood transfusion may affect the prognosis of lung transplantation.
      Objective  To analyze the factors associated with intraoperative blood transfusion during lung transplantation in a single center, and explore the relationship between blood transfusion and prognosis of lung transplantation.
      Methods  This retrospective analysis included 194 consecutive lung transplantations in our hospital from March 2017 to June 2019. The lung transplant recipients were divided into blood transfusion group (n=65) and non-blood transfusion group (n=129) according to the blood transfusion during operation. Clinical data about patients in the two groups, the risk factors of transfusion during operation and their prognosis were analyzed.
      Results  The incidence of blood transfusion was 33.5%. Preoperative anticoagulant therapy, low preoperative hemoglobin, high preoperative international normalized ratio (INR), intrathoracic adhesion and long operation time resulted in increased blood transfusion (P＜0.05). The overall survival rate of transfusion recipients was significantly lower than that of the non-transfusion recipients (P＜0.05). Logistic regression showed that preoperative anticoagulant therapy (OR=4.551, P=0.006), high preoperative international standardized ratio (OR=2.964, P=0.004), intrathoracic adhesion (OR=4.560, P=0.000), low preoperative hemoglobin (OR=0.462, P=0.045) and long operation time (OR=6.106, P=0.000) were significantly associated with blood transfusion. The incidence of primary graft dysfunction (PGD) grade 3 (26.2% vs 10.9%, P=0.01) and mortality within 30 days after operation (32.3% vs 14.7%, P＜0.01) in the transfusion group were higher than those in the non-transfusion group.
      Conclusion  Preoperative anticoagulation therapy, low preoperative hemoglobin, high preoperative INR, intrathoracic adhesion and long operation time are risk factors of intraoperative transfusion. The prognosis of patients with blood transfusion is worse than that of patients without blood transfusion.

     

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