摘要
目的探讨术中大量输注红细胞对肿瘤手术患者多临床检验指标及预后的影响,以便为有效干预大量输血引起的并发症提供依据。方法选择2019年1月~2020年12月在本院接受肿瘤切除术且术中输注红细胞>10 U的208名患者作为研究对象,按输血量不同分为A组:10~15 U,144人;B组:>15~25 U,48人;C组:>25 U,16人。收集并比较3组患者手术前后的肝功能、凝血、电解质、血小板计数指标数据及短期预后的情况。结果A、B、C 3个组大量输血(量)不同肿瘤手术患者术前ALT、AST、TBIL相近(P>0.05);AST(U/L)手术前后比较:105.33±238.18 vs 113.50±185.04 vs 291.25±457.33(P<0.05);术后PT(s)为14.12±2.10、14.79±2.67、16.10±4.06,INR为1.25±0.20、1.31±0.26、1.44±0.38,APTT(s)为30.52±5.63、34.57±12.80、34.80±10.49,均较术前明显延长(P<0.05);Plt(×10;/L)为142.32±70.07、100.04±57.50、85.40±41.10,较术前明显降低(P<0.05);术后血清K^(+)、Ca^(2+)明显降低,Na^(+)、Cl^(-)明显升高,pH值降低(P<0.05);住院时间(d)为17.74±14.83 vs 20.92±17.69 vs 33.73±34.62(P<0.05),病死率(%)为2.8(4/144)vs 6.3(3/48)vs 18.8(3/16)(P<0.05)。结论肿瘤患者术后出现肝功能和凝血功能障碍或与术中大量输注红细胞及其导致的酸碱失衡和电解质紊乱有关;红细胞输注量越大,患者的这些临床检测指标越异常、住院时间越长,短期预后越差。
Objective To explore the effects of massive intraoperative RBC transfusion on multiple clinical test indicators and prognosis of patients,underwent tumor surgery in order to provide evidence for rational blood transfusion and effective intervention of complications caused by massive blood transfusion in tumor patients.Methods A total of 208 patients who underwent tumor resection in our hospital from January 2019 to December 2020 and received intraoperative RBC transfusion(>10 U)were selected as the study subjects.According to the amount of blood transfusion,they were divided into group A:10~15 U,144 patients;Group B:>15~25 U,48 people;Group C:>25 U,16 people.Data of liver function,coagulation,electrolyte,platelet count and short-term prognosis were collected and compared among 3 groups before and after surgery.Results No significant difference was noticed in patient pre-operation variables including ALT(U/L),AST(U/L)and TBIL(μmol/L)among three groups recieved massive blood transfusion(P>0.05),while AST was significantly lower than that after operation(P<0.05):105.33±238.18 vs 113.50±185.04 vs 291.25±457.33(P<0.05).After operation,PT(s)(14.12±2.10,14.79±2.67 and 16.10±4.06),INR(1.25±0.20,1.31±0.26 and 1.44±0.38)and APTT(s)(30.52±5.63,34.57±12.80 and 34.80±10.49)extended significantly than those before operation(P<0.05),while Plt(×10~9/L)decreased significantly(142.32±70.07,100.04±57.50 and 85.40±41.10)(P<0.05).After operation,serum K^(+)and Ca^(2+)decreased significantly,Na^(+)and Cl^(-)increased significantly,and pH value decreased(P<0.05).Hospital stay of group C(d)was 33.73±34.62 vs 17.74±14.83 vs 20.92±17.69(P<0.05).The mortality rate was 2.8%(4/44)vs 6.3%(3/48)vs 18.8%(3/16)(P<0.05),and mortality rate of group C was higher than the other two groups.Conclusion Postoperative dysfunction of liver and coagulation in tumor patients may be related to intraoperative RBC transfusions and consequent acid-base imbalance and electrolyte disturbance.The more the units of RBC transfused,the more abnorm
作者
翁雪姿
莫洲沛
梁永能
柯妙拉
林文前
WENG Xuezi;MO Zhoupei;LIANG Yongneng;KE Miaola;LIN Wenqian(Sun Yat-sen University Cancer Center,Department of Blood Transfusion,Guangzhou 510000,China)
出处
《中国输血杂志》
CAS
2022年第6期608-611,共4页
Chinese Journal of Blood Transfusion
关键词
术中大量输血
肿瘤患者
红细胞输注量
肝功能
凝血功能
短期预后
intraoperative massive transfusion
tumor patients
RBC transfusion
coagulation function
liver function
short-term prognosis
