摘要
目的 探讨优化冠状动脉旁路移植(CABG)手术患者术前血红蛋白(Hb)水平对临床转归的影响。方法 回顾性分析本院2020年4月至2021年8月择期行CABG的患者。收集符合入选标准患者术前的基础资料以及围术期的输血量、输血率、急性肝功能损害、急性肾功能损害(AKI)、ICU停留时间、住院时间及住院死亡率。根据患者围术期是否输注红细胞,利用受试者工作特征曲线(ROC)计算术前Hb最佳阈值,依据阈值将所有患者分为两组,比较两组的输血量及临床结局,评估Hb最佳阈值的预测价值。结果 共有915名符合入选标准的患者被纳入研究,通过ROC曲线计算术前Hb值预测红细胞输注率的最佳阈值为男性118 g/L、女性116 g/L。A组:Hb≤阈值(n=293)分为红细胞输注组A1与红细胞未输注组A2;B组:Hb>阈值(n=622)分为红细胞输注组B1与红细胞未输注组B2。导致围手术期红细胞输注的危险因素有年龄(OR=1.033 874,95%CI1.000 4~1.068 3,P<0.01)、性别(女)(OR=3.268 5,95%CI2.353 1~4.540 0,P<0.01)、BMI(OR=0.927 8,95%CI0.883 3~0.974 4,P<0.01)、慢性肾功能不全(CKD)(OR=2.041 1,95%CI 1.347 8~3.091 0,P<0.01)。术前Hb≤阈值(OR=3.517 4,95%CI2.502 1~4.944 7,P<0.01)是围手术期红细胞输注的独立危险因素。术前Hb≤阈值患者围术期输注红细胞进一步增加术后并发症的发生率(急性肝损伤、AKI)的发生率及ICU停留时间。结论 患者术前Hb>阈值可以有效的减少CABG患者围术期输注红细胞,降低术后急性肝损伤、AKI、ICU停留时间及住院时间延长的风险。优化CABG患者术前Hb水平,将男性Hb提升至118 g/L、女性提升至116 g/L可减少围术期红细胞输注及术后并发症的发生率。
Objective To investigate the effect of optimized preoperative hemoglobin(Hb) level on clinical outcome in patients undergoing coronary artery bypass grafting(CABG). Methods Retrospective analysis was performed on patients who were selected to receive CABG from April 2020 to August 2021 in our hospital. Preoperative basic data, perioperative blood transfusion volume, blood transfusion rate, acute liver function impairment, renal function impairment(AKI), ICU stay, length of hospital stay, and in-hospital mortality of patients, meeting the inclusion criteria, were collected. According to the perioperative red blood cell transfusion, the optimal preoperative Hb threshold was calculated by receiver operating characteristic curve(ROC). According to the threshold, all patients were divided into two groups, and the blood transfusion volume and clinical outcomes of the two groups were compared to evaluate the predictive value of the optimal threshold of Hb. Results A total of 915 patients who met the inclusion criteria were enrolled in the study. The optimal threshold for predicting red blood cell transfusion rate by calculating preoperative Hb value by ROC curve was 118 g/L for males and 116 g/L for females. Group A:Hb≤ threshold(n=293) was divided into the red blood cell transfusion group A1 and the red blood cell non-transfusion group A2. Group B:Hb>threshold(n=622) was divided into the red blood cell non-transfusion group B1 and no red blood cell non-transfusion group B2. The risk factors for perioperative red blood cell transfusion were age(OR=1.033 874, 95%CI 1.000 4-1.068 3, P<0.01), gender(female)(OR=3.268 5, 95%CI 2.353 1-4.540 0, P<0.01), BMI(OR=0.927 8, 95%CI 0.883 3-0.974 4, P<0.01), chronic renal insufficiency(CKD)(OR=2.041 1, 95%CI 1.347 8-3.091 0, P<0.01). Preoperative Hb≤ threshold(OR=3.517 4, 95%CI 2.502 1-4.944 7, P<0.01) was an independent risk factor for perioperative red blood cell transfusion. Perioperative red blood cell transfusion in patients with preoperative anemia further increases the inc
作者
杨杰
陶翠华
张李涛
蒋丽媛
廖鑫
孙姜尚
王佳雯
胡应森
YANG Jie;TAO Cuihua;ZHANG Litao;JIANG Liyuan;LIAO Xin;SUN Jiangshang;Wang Jiawen;HU Yingsen(Department of Transfusion Medicine,Wuhan Yaxin General Hospital Afiliated to Wuhan University of Science and Technology,Wuhan 430070,China)
出处
《中国输血杂志》
CAS
2022年第12期1226-1230,共5页
Chinese Journal of Blood Transfusion
基金
武汉市卫生健康委科研项目(WX20D23)。
关键词
术前贫血
冠脉旁路移植术
血红蛋白优化水平
围术期红细胞输注
术后并发症
preoperative anemia
coronary artery bypass grafting
optimal level of hemoglobin
perioperativeblood transfusion
postoperative complications
