摘要
目的探讨影响原发性肝癌患者肝癌切除术围术期红细胞输注的危险因素,为肝癌患者术前血液管理及围术期用血安全性提供理论支持。方法收集本院2014年12月—2016年12月住院治疗并接受肝癌切除手术的原发性肝癌病例资料,按术中输血与否分为输血组(n=132)和未输血组(n=542),比较2组患者的临床基本资料、手术相关指标、术前实验室检查结果和生存结局;采用单因素和多因素Logistic回归分析筛选围术期红细胞输注的危险因素。结果共收集674例原发性肝癌切除术病例资料,围术期红细胞输注率19.6%(132/674),未输血率80.4%(542/674);描述性分析:输血组与未输血组甲胎蛋白(AFP)、美国麻醉医师协会(ASA)分级、美国东部肿瘤协作组(ECOG)体能状况评分、肝细胞癌TNM分期、HBsAg、肿瘤大小、有卫星造(25.8%vs 16.6%)、血管侵犯(18.9%vs 12.4%)、肝脏切除范围≥3段(43.2%vs 24.5%)、术中失血量(mL)(807.6±679.0 vs 281.6±214.6)、术前PT(s)(11.9±1.3 vs 11.5±1.5)、APTT(s)(30.3±26.7 vs 27.3±4.5)、Fib(g/L)(2.9±1.2 vs 2.7±0.9)、Hb(g/L)(126.2±21.8 vs 140.0±20.0)、总住院时间(d)(18.5±9.7 vs 14.3±5.7)以及生存结局均具有明显差异(P<0.05)。Kaplan-Meier生存分析:输血组与未输血组患者的总生存率分别为48.9%(46/94)vs 72.9%(283/388)(P<0.01);多因素Logistic回归分析:甲胎蛋白(AFP)(OR=2.082,P<0.05)、ASA(OR=5.159,P<0.01)、AST(OR=0.978,P<0.01)、Fib(OR=1.265,P<0.05)、围术期输血(OR=1.862,P<0.05)及输血量(OR=1.001,P<0.05),AFP(OR=4.413,P<0.01)、TNM(OR值分别为3.240、3.309、3.337,P<0.05)、术中失血量(OR=1.475,P<0.01)以及术前Hb(OR=0.974,P<0.01)。结论围术期异体红细胞输注与原发性肝癌患者肝癌切除术后的总生存率降低相关;而AFP、肝细胞癌TNM分期、术中失血量以及术前Hb均为原发性肝癌围术期红细胞输注的独立危险因素。
Objective To analyze the risk factors of perioperative red blood cell transfusion in patients with primary liver cancer.Methods We retrospectively analyzed 674 patients with primary liver cancer who underwent hepatectomy in our hospital from December 2014 to December 2016.According to whether received allogeneic red blood cell transfusion during surgery,patients were divided into transfusion group(n=132)and non-transfusion group(n=542).The clinical basic data,surgical related indicators,blood transfusion-related laboratory test results and postoperative prognosis indicators were compared and analyzed.We performed univariate and multivariate logistic regression analysis to screen perioperative blood transfusion-related factors that influence the prognosis of patients.Results A total of 674 cases of primary hepatocellular carcinoma underwent resection were collected,Perioperative red blood cell transfusion rate was 19.6%(132/674)and non-transfusion rate was 80.4%(542/674).Descriptive analysis:AFP,ASA and ECOG,TNM stage,HBsAg,tumor size,satellites(25.8%vs 16.6%),vascular invasion(18.9%vs 12.4%),extent of hepatectomy≥3(43.2%vs 24.5%),intraoperative blood loss(mL)(807.6±679.0 vs 281.6±214.6),preoperative PT(s)(11.9±1.3 vs 11.5±1.5),APTT(s)(30.3±26.7 vs 27.3±4.5),Fib(g/L)(2.9±1.2 vs 2.7±0.9)、Hb(g/L)(126.2±21.8 vs 140.0±20.0),total hospitalization(d)(18.5±9.7 vs 14.3±5.7)and survival outcome were all statistically significant(P<0.05)between the two groups.Kaplan-Meier survival survival analysis:The overall survival rates were 48.9%(46/94)vs 72.9%(283/388)(P<0.01).Multivariate logistic regression analysis:AFP(OR=2.082,P<0.05),ASA(OR=5.159,P<0.01),AST(OR=0.978,P<0.01),Fib(OR=1.265,P<0.05),perioperative blood transfusion(OR=1.862,P<0.05)and blood transfusion volume(OR=1.001,P<0.05)were independent factors related to survival outcome(P<0.05).AFP(OR=4.413,P<0.01),TNM stage(OR 3.240,3.309,3.337,P<0.05),intraoperative blood loss(OR=1.475,P<0.01)and preoperative Hb(OR=0.974,P<0.01).Conclusion Perioperative allog
作者
钱雪萌
齐祺
夏荣
张琦
QIAN Xuemeng;QI Qi;XIA Rong;ZHANG Qi(Department of Blood Transfusion,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China)
出处
《中国输血杂志》
CAS
2019年第5期452-457,共6页
Chinese Journal of Blood Transfusion
基金
国家自然科学基金面上项目(81570166和81670173)
上海市公共卫生重点学科建设项目(No.15GWZK0501)
关键词
原发性肝癌
肝切除术
围术期输血
异体红细胞
输血危险因素
primary liver cancer
hepatectomy
perioperative transfusion
allogeneic red blood cell
transfusion risk factors
