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| 成人脊柱手术患者术中输血情况的回顾性分析 |
| Retrospective analysis of intraoperative blood use in adult spine surgery |
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| DOI：10.12089/jca.2019.03.005 |
| 中文关键词: 脊柱手术 红细胞悬液 血浆 回收式自体输血 |
| 英文关键词: Spine surgery Red blood cells Plasma Intra-operative cell salvage |
| 基金项目:北京大学第三医院院临床重点支持项目（BYSY2017001） |
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| 中文摘要: |
目的 回顾性分析近5年骨科成人脊柱手术患者手术中用血的情况。
方法 建立2013年1月1日至2017 年12月31日所有骨科脊柱手术成年患者的基本数据库共26 959例，男15 034例，女11 925例，年龄（53.6±12.0）岁，BMI （25.4±3.7）kg/m2，ASA Ⅰ—Ⅲ 级。所有患者按年度分为五组：2013年、2014年、2015年、2016年、2017年；并按不同手术类型进行分组：颈椎手术组（C组）、胸椎手术组（T组）、腰椎手术组（L组）、复杂脊柱手术组（M组）。 比较不同年度、不同手术类型的脊柱手术患者术中血液制品和回收式自体输血 （intra-operative cell salvage, IOCS）的使用情况，包括2013—2017年每年红细胞悬液（red blood cells, RBC）和冰冻血浆（frozen plasma，FP）输注率和平均输注量，2013—2017年每年自体血输注率、自体血回输总量和平均回输量，C组、T组、L组和M组RBC和FP的输注率、平均输注量，自体血回输率和平均回输量。
结果 2016年、2017年RBC和FP输注率明显高于2013年、2014年和2015年（P<0.05），2013年、2014年RBC平均输注量明显高于2015年、2016年和2017年（P<0.05），2014年FP平均输注量明显高于2013年、2015年、2016年和2017年（P<0.05）。2013年自体血平均回输量明显高于2014年、2015年、2016年和2017年（P<0.05）。M组RBC和FP输注率明显高于C组、T组和L组（P<0.05），L组自体血输注率明显高于C组、T组和M组（P<0.05）。M组、T组RBC平均输注量和自体血平均回输量明显高于C组和L组（P<0.05），M组FP平均输注量明显高于C组和L组（P<0.05），且M组自体血平均回输量明显高于T组（P<0.05）。
结论 回收式自体输血应用于脊柱手术患者，节约了大量的血源。胸椎手术、复杂脊柱手术对血液制品需求量大，这些患者减少异体血的使用量需要更个体化和精细化的血液管理措施。 |
| 英文摘要: |
Objective To retrospectively analyze the intraoperative blood use of adult patients with spine surgery in the last 5 years.
Methods The basic database which included all adult patients with spine surgery in orthopedics department from January 1, 2013 to December 31, 2017 was established. 26 959 patients were recorded in the database, with 15 034 males and 11 925 females, aged (53.6 ± 12.0) years , BMI (25.4 ± 3.7) kg/m2, ASA physical status Ⅰ - Ⅲ. All patients were divided into five groups according to the year of surgery, named 2013, 2014, 2015, 2016 and 2017. All patients were simultaneously grouped according to different types of surgery, including cervical spinal surgery group (group C), thoracic spinal surgery group (group T), lumbar spinal surgery group (group L), and multi-segment spinal group (group M). The usage of blood products and intra-operative cell salvage (IOCS) in different groups were compared. The infusion rate, average infusion volume of red blood cell (RBC) and frozen plasma (FP), the transfusion rate, total volume, and average infusion volume of autologous blood transfusion were analyzed and compared annually. RBC and FR infusion rates, average infusion volume, autologous blood transfusion rate and average infusion volume were compared among groups C, T, L and M.
Results The infusion rate of RBC and FP in 2016 and 2017 were significantly higher than that in 2013, 2014 and 2015 (P < 0.05). The average infusion volume of RBC in 2013 and 2014 were significantly higher than that in 2015, 2016 and 2017 (P < 0.05). The average infusion volume of FP in 2014 was significantly higher than that in 2013, 2015, 2016 and 2017 (P < 0.05). The average volume of autologous blood transfusion in 2013 was significantly higher than that in 2014, 2015, 2016 and 2017 (P < 0.05). The RBC and FP transfusion rate in group M were significantly higher than that in group C, T and L (P < 0.05), and the autologous blood transfusion rate in group L was significantly higher than that in group C, T and M (P < 0.05). The mean transfusion volume of RBC and autologous blood in group M and T were significantly higher than that in group C and L (P < 0.05). The average infusion volume of FP in group M was significantly higher than that in group C and group L (P < 0.05). The mean transfusion volume of autologous blood in group M was significantly higher than that in group T (P < 0.05).
Conclusion IOCS can save a lot of blood source in spine surgery. Thoracic and complicated spine surgeries are in great demand for blood products. Individualized and precise blood management for these patients may further reduce the use of allogeneic blood |
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