摘要
目的 筛选体外循环（CPB）心脏手术患者围手术期（简称围术期）发生大量出血的危险因素.方法 回顾性分析2001年1月至2010年5月浙江大学医学院附属邵逸夫医院择期行心脏手术的成人患者1079例,根据是否有围术期大量出血,分为2组：大量出血组和非大量出血组,两组分别为120例和959例.可疑的危险因素进行组间比较后,将差异有统计学意义的因素进行Logistic回归分析,筛选发生围术期大量出血的危险因素.结果 围术期发生大量出血120例,发生率为11.1％.Logistic回归分析显示,大量出血的危险因素为：年龄（OR=4.533,95％ CI 2.624～7.831）、有心脏手术史（ OR=2.781,95％ CI 1.410～5.486）、术前红细胞压积（Hct）水平（OR=0.896,95％ CI0.861～0.932）、CPB时间（OR=2.782,95％ CI1.791～4.322）、手术类型（OR=2.292,95％ CI1.376～3.817）.结论 老年、心脏手术史、术前低Hct水平、CPB时间≥120 min、复杂手术为CPB心脏手术围术期发生大量出血的独立危险因素.
Objective To evaluate the pre- and intraoperative risk factors associated with excessive bleeding during the perioperative period in adult patients undergoing open heart surgery with cardiopulmonary bypass （CPB）.Methods A total of 1079 consecutive patients undergoing open heart surgery with CPB from January 2001 to May 2010 were included （ except for emergency operation）.The possible risk factors associated with excessive bleeding were retrospectively analyzed.Patients who received ≥7 units of RBC or had a re-operation during which no active bleeding point was found within one day of operation were classified as excessive bleeding.According to the occurrence of excessive bleeding,they were divided into 2 groups：excessive and non-excessive bleeding groups.The possible risk factors associated with excessive bleeding were retrospectively analyzed.Univariate analysis and multivariate Logistic regression analysis were used to examine the relationship between these factors and excessive bleeding. Results Among them,120（11.1% ） developed excessive bleeding.Multivariate Logistic analysis indicated that the risk factors for excessive bleeding were age （ OR =4.533,95% CI 2.624 - 7.831 ）,previous sternotomy （ OR =2.781,95% CI 1.410 - 5.486 ）,preoperative hematocrit concentration （ OR =0.896,95% CI 0.861 - 0.932 ）,CPB duration （ OR =2.782,95 % CI 1.791 - 4.322） and type of procedure （ OR =2.292,95% CI 1.376 -3.817）.Conclusion Age ≥ 65 years,previous sternotomy,preoperative low hematocrit concentration,CPB duration ≥ 120min and complex operation were the significant predictors for excessive bleeding in patient undergoing open heart surgery with CPB.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第5期316-319,共4页
National Medical Journal of China
关键词
体外循环
手术后出血
危险因素
Extracorporeal circulation
Postoperative hemorrhage
Risk factors
