回顾性分析老年骨科患者用血特点及影响因素*

doi:10.3969/j.issn.1671-2587.2022.06.011

临床输血与检验 ›› 2022, Vol. 24 ›› Issue (6): 736-742.DOI: 10.3969/j.issn.1671-2587.2022.06.011

回顾性分析老年骨科患者用血特点及影响因素^*

魏超, 胥俊越, 席朝运, 赵锦阳, 关迺喆, 汪德清

100073 首都医科大学电力教学医院输血科（魏超,赵锦阳,关迺喆）; 首都医科大学电力教学医院检验科（胥俊越）; 湘西土家族苗族自治州人民医院输血科（席朝运）; 中国人民解放军总医院第一医学中心输血医学科（汪德清）

收稿日期:2022-08-13 发布日期:2023-01-05
通讯作者: 汪德清,教授,主任医师,（E-mail）deqingw@vip.sina.com。关迺喆,副主任医师,（E-mail）guannaizhe888@126.com。
作者简介:魏超（1988-）,女,主治医师,硕士,主要从事临床输血研究,（E-mail）weichaohaha@126.com。
基金资助:
*本课题受北京电力医院院级课题（No.Y2022003）资助

Retrospective Analysis on Characteristics and Influencing Factors of Blood Transfusion in Elderly Orthopedic Patients

WEI Chao, XU Jun-Yue, XI Chao-Yun, et al

Department of Blood Transfusion, Electric Power Teaching Hospital, Capital Medical University, Beijing 100073

Received:2022-08-13 Published:2023-01-05

摘要/Abstract

摘要： 目的探究老年骨科患者用血特点和异体输血影响因素,为此类患者临床用血管理提供思路。方法纳入年龄≥60周岁骨科患者648例,其中住院期间手术患者598例,保守治疗患者50例,比较分析手术和保守治疗两组用血特点。根据疾病分类和手术用血特点,本研究将598例老年骨科手术患者分为8组,598例手术患者根据围术期异体输血情况,分为输血组和未输血组,比较两组间患者术前基线资料、围手术期血液流变学指标、自体血用量、住院时间和住院期间死亡率的差别,并计算其P值。选择两组比较P<0.1的变量、手术分类和自体输血量等,建立多重多元logistics回归方程,最终分析得出影响老年骨科手术患者异体输血的主要因素。结果影响老年骨科手术围术期异体输血的变量为术前Hb（OR：0.948,P<0.001）、脑梗病史（OR：1.844,P=0.034）、术中出血量（OR：1.005,P<0.001）、术中自体输血量（OR：0.995,P=0.005）、骨科手术分类（OR：1.466,P<0.001）和术后D-二聚体（OR：1.111,P=0.038）。结论术前Hb和术中自体输血量为老年骨科手术患者异体输血的保护性因素;脑梗病史、术中出血量、骨科手术分类（输血概率由低到高）和术后D -二聚体为老年骨科手术患者异体输血风险因素。

关键词: 老年骨折, 贫血, 输血管理, 影响因素

Abstract: Objective To investigate the characteristics of blood use and influencing factors of allogeneic blood transfusion in elderly orthopedic patients, thus providing information beneficial to the clinical management of blood use for such patients. Methods A total of 648 orthopedic patients age≥60 years were included, with 598 undergoing surgery and 50 conservative treatment. The blood use characteristics of surgical and conservative treatment groups were compared and analyzed. According to the disease classification and characteristics of blood use in surgery, 598 elderly patients undergoing orthopedic surgery were divided into eight groups. According to whether the patients received allogeneic transfusion or not, 598 patients were assigned into the transfusion group and the non-transfusion group. Preoperative baseline data, perioperative hemorheology indexes, autologous blood dosage, length of stay and in-hospital mortality were compared between the two groups, and their P values were calculated. Two groups were selected to compare P<0.1 variables, surgical classification and autotransfusion volume, etc, establish multiple multivariate logistic regression equation, and finally analyze the main factors affecting allogeneic blood transfusion in elderly orthopedic surgery patients. Results The variables influencing perioperative allogeneic blood transfusion in elderly orthopaedic surgery were Hb (OR: 0.948, P<0.001), cerebral infarction medical history (OR: 1.844, P=0.034), intraoperative blood loss (OR:1.005, P<0.001), intraoperative autotransfusion volume (OR: 0.995, P=0.005), orthopedic surgery classification (OR: 1.466, P<0.001) and postoperative D-dimer (OR:1.111, P=0.038). Conclusion Preoperative Hb and intraoperative autotransfusion volume were protective factors for allogeneic transfusion in elderly patients undergoing orthopedic surgery. History of cerebral infarction, intraoperative blood loss, orthopedic surgery classification (from low to high probability of transfusion) and postoperative D-dimer were the risk factors for allogeneic transfusion in elderly patients undergoing orthopedic surgery.

Key words: Senile fracture, Anemia, Transfusion management, Influence factors

中图分类号:

R457.1

魏超, 胥俊越, 席朝运, 赵锦阳, 关迺喆, 汪德清. 回顾性分析老年骨科患者用血特点及影响因素^*[J]. 临床输血与检验, 2022, 24(6): 736-742.

WEI Chao, XU Jun-Yue, XI Chao-Yun, et al. Retrospective Analysis on Characteristics and Influencing Factors of Blood Transfusion in Elderly Orthopedic Patients[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2022, 24(6): 736-742.

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回顾性分析老年骨科患者用血特点及影响因素^*

Retrospective Analysis on Characteristics and Influencing Factors of Blood Transfusion in Elderly Orthopedic Patients

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