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| 限制性输血策略与急性Stanford A型主动脉夹层患者预后的相关性 |
| Relationship between restrictive blood transfusion strategy and the prognosis of patients with acute Stanford type A aortic dissection |
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| DOI：10.12089/jca.2020.11.006 |
| 中文关键词: 限制性输血 急性Stanford A型主动脉夹层 心肺转流 深低温停循环 预后 |
| 英文关键词: Restricted transfusion Acute Stanford type A aortic dissection Cardiopulmonary bypass Deep hypothermic circulatory arrest Outcomes |
| 基金项目:深圳市科创委知识创新计划基础研究项目（JCYJ20170307161610240） |
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| 中文摘要: |
目的 分析限制性输血策略与急性Stanford A型主动脉夹层患者预后的相关性。
方法 回顾性分析2017年11月至2019年12月本院收治的急性Stanford A型主动脉夹层患者94例，男80例，女14例，年龄23~76岁，BMI 17.8~35.9 kg/m2，ASA Ⅳ级。根据输血策略不同将患者分为两组：限制性输血组（R组，n=48）和传统输血组（C组，n=46）。R组围术期采用限制性输血策略，C组围术期采用传统输血策略。记录术前一般资料、术中心肺转流时间、主动脉阻断时间和深低温停循环时间，术中和术后24 h异体输血量、术后24 h胸腔引流量、术后1 d的红细胞计数（RBC）、血红蛋白（Hb）、血小板计数（Plt）、活化部分凝血活酶时间（APTT）和凝血酶原时间（PT），机械通气时间、ICU住院时间、总住院时间、术后急性肺损伤、急性肾损伤、连续肾脏替代治疗、感染和谵妄发生率，住院期间死亡率。
结果 两组患者在术前一般资料、术中心肺转流时间、主动脉阻断时间及深低温停循环时间差异无统计学意义。与C组比较，R组术中及术后24 h异体红细胞悬液、血浆及冷沉淀用量明显减少（P＜0.01），术后1 d的RBC和Hb明显降低（P＜0.01），术后1 d的APTT和PT明显升高（P＜0.05），机械通气时间和ICU住院时间明显缩短（P＜0.01）。两组患者术中和术后24 h异体血小板用量、术后1 d的Plt、术后24 h胸腔引流量、总住院时间、术后急性肺损伤、急性肾损伤、连续肾脏替代治疗、感染、谵妄和住院期间死亡率差异无统计学意义。
结论 限制性输血策略可以减少急性Stanford A型主动脉夹层患者围术期异体红细胞悬液、血浆及冷沉淀用量，且未增加住院期间并发症及死亡率。 |
| 英文摘要: |
Ojective To analyze the relationship between restrictive blood transfusion strategy on the prognosis of patients with acute Stanford type A aortic dissection.
Methods Ninety-four patients with acute Stanford type A aortic dissection treated in our hospital from November 2017 to December 2019 were retrospectively analyzed, 80 males and 14 females, aged 23-76 years, BMI 17.8-35.9 kg/m2, falling into ASA physical status Ⅳ. According to different blood transfusion strategies, patients were divided into the restricted transfusion group (group R, n = 48) and the traditional transfusion group (group C, n = 46). In group R, restrictive blood transfusion strategy was used during perioperative period, while traditional blood transfusion strategy was used in group C. Preoperative general information, cardiopulmonary bypass time, aortic cross clamp time, deep hypothermia circulatory time, the amount of allogeneic blood transfusion during operation and 24 h after operation, thoracic drainage within 24 h after operation, amount of red blood cell within 24 h (RBC), hemoglobin (Hb), platelet (Plt), activated partial thromboplastin time (APTT), prothrombin time (PT) 1 d after operation, mechanical ventilation time, length of ICU stay, total length of hospital stay, the incidences of postoperative acute lung injury, acute kidney injury, continuous renal replacement therapy, infection, delirium, and mortality during hospitalization were recorded.
Results There was no statistically significant difference between two groups in the preoperative general information, intraoperative cardiopulmonary bypass time, aortic cross clamp time and deep hypothermia circulatory time. Compared with group C, the amount of allogeneic red blood cells suspension, plasma and cryoprecipitate in group R were significantly reduced during operation and 24 h after operation (P < 0.01), RBC and Hb on the first day after operation were significantly decreased (P < 0.01), APTT and PT were significantly increased on the first day after operation (P < 0.05), mechanical ventilation time and length of ICU stay were significantly shortened (P < 0.01). There were no statistically significant differences in the amount of allogeneic platelets during operation and 24 h after operation, platelet count 1 day after operation, thoracic drainage within 24 h after operation, total length of hospital stay, the incidences of postoperative acute lung injury, acute kidney injury, continuous renal replacement therapy, infection and delirium, and mortality during hospital stay between two groups.
Conclusion Restrictive transfusion strategy can reduce the amount of perioperative allogeneic red blood cells suspension, plasma and cryoprecipitate among patients with acute Stanford type A aortic dissection without increasing complications and mortality during hospitalization. |
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