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临床输血与检验

临床输血与检验 ›› 2024, Vol. 26 ›› Issue (1): 79-85.DOI: 10.3969/j.issn.1671-2587.2024.01.013

• 临床输血 • 上一篇    下一篇

结直肠癌贫血患者围手术期用血影响因素分析: 一项单中心2013—2020年数据

陈岩, 陈麟凤, 何欣, 王岩, 于文娟, 刘璇, 刘思琪   

  1. 首都医科大学附属北京世纪坛医院输血科,北京 100038
  • 收稿日期:2023-11-25 发布日期:2024-03-13
  • 通讯作者: 陈麟凤,主要从事临床用血质量管理、临床疑难输血及单采治疗等临床研究工作,（E-mail）clf@bjsjth.cn。
  • 作者简介:陈岩,主要从事临床输血相容性检测、单个核细胞采集的工作,（E-mail）chenyan0229c@sina.com。

Factors Influencing Perioperative Blood Transfusions in Patients with Colorectal Cancer: Single-Center Data from 2013 To 2020

CHEN Yan, CHEN Linfeng, HE Xin, WANG Yan, YU Wenjuan, LIU Xuan, LIU Siqi   

  1. Department of Blood Transfusion, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038
  • Received:2023-11-25 Published:2024-03-13

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摘要： 目的 通过分析影响结直肠癌贫血患者围手术期红细胞输注量的主要因素,为临床围术期用血提供依据,提高临床输血的合理性。方法 收集2013年1月—2020年1月我院295例结直肠癌贫血患者的临床资料、实验室检查资料和围手术期红细胞输注情况。对输血过程中涉及的主要因素,如患者年龄、性别、术前血红蛋白水平、术前凝血、手术时间、肿瘤部位、肿瘤体积、肿瘤分期、住院时间等进行分类分析。结果 295例术中失血量大于600 mL者106例（35.9%）,术中红细胞输注率为49.2%。红细胞输注率较高与术前贫血（Hb<100 g/L）率（51.0%）较高有关。术中红细胞输血量占围手术期用血的52.1%。通过多变量logistic回归分析,发现对术中红细胞输注影响最大的因素是年龄（P<0.001）和肿瘤部位（结肠癌P=0.004;直肠癌P=0.003）。对于围手术期红细胞输注量而言,显著相关的变量是肿瘤体积（P=0.037）,而患者年龄、性别与围手术期红细胞输注量无显著相关性（P>0.05）。红细胞输注量与住院时间（术中P=0.428,围手术期P=0.604）、手术切口类型（P=0.784）或切口愈合（P=0.056）等均无显著相关性。术中红细胞与血浆输注比例合理,无“匹配全血输注”。结论 影响围手术期红细胞输注量的主要因素是患者肿瘤部位和肿瘤体积,与患者年龄、性别、术前血红蛋白水平、手术时间及肿瘤TNM分期关系不大。围手术期血液管理对于减少输血和缩短住院时间至关重要。

关键词: 结直肠癌, 术中输血, 围手术期输血, 患者血液管理

Abstract: Objective To investigate the affecting factors of perioperative red blood cell transfusions in patients with colorectal cancer, thus providing evidence for rational use of blood in clinic. Methods Data were collected from January, 2013 to January, 2020 regarding clinical records, laboratory tests and perioperative blood transfusions of 295 patients in our hospital. The main factors involved in the red blood cell transfusion process, i.e. patient's age, gender, preoperative hemoglobin level, preoperative coagulation, operation time, tumor location, tumor volume, tumor staging, hospital stay were classified and analyzed. Results Of the 295 patients, 106 (35.9%) had intraoperative blood loss greater than 600 mL, the intraoperative blood transfusion rate being 49.2%. The higher transfusion rate was associated with preoperative anemia (Hb <100 g/L) in 51.0% of patients. The volume of intraoperatively transfused red blood cells accounted for 52.1% of the blood perioperatively used. Multivariate logistic regression analysis showed the most influential factors that affected the volume of intraoperative red blood cells were patients'age（P<0.001）and cancer location (P=0.004 for colon cancer; P=0.003 for rectal cancer), which were statistically significant predictors. In terms of the perioperative red blood cell transfusion volume, the significantly associated variable was tumor size (P=0.037). Significant correlation was observed neither between patient age, gender and perioperative blood transfusion (P>0.05) nor between red blood cell volume and length of hospital stay (inter-operative P=0.428, perioperative P=0.604), surgical incision type（P=0.784）, or incision healing（P=0.056）. The ratio of red blood cell to plasma infusion was reasonable during the operation, and there was no need for "matched whole blood" infusion. Conclusion The main influencing factors of perioperative blood transfusions are tumor location and size instead of patients'age, sex, preoperative hemoglobin level, operation time and tumor staging. Perioperative blood management is essential to reduce blood transfusion and shorten hospital stay.

Key words: Colorectal neoplasms, Intraoperative blood transfusion, Perioperative blood transfusion, Patient blood management

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