腹膜后肿瘤患者术中输血影响因素及预后分析
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摘要
目的分析腹膜后肿瘤患者术中输血的影响因素及术后的预后情况。方法回顾性分析136例腹膜后肿瘤手术患者临床资料,用χ~2检验对术中输血组和未输血组患者指标进行单因素分析,将P<0.05的指标进一步纳入多因素Logistic回归分析,得到患者术中输血的影响因素。选取患者术后的预后影响因素,对比两组患者差异。结果在术中输血组与未输血组患者中,脂肪肉瘤都是最为多见的组织学分型,分别占38.5%(20/52)和17.9%(15/84)。单因素分析显示脂肪肉瘤构成比、多次手术、联合切除脏器、肿瘤累及大血管、肿瘤长径>10 cm、术前APTT>39 s、术前Hb<110 g/L等7个因素在两组间比较差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示肿瘤长径>10 cm、多次手术、肿瘤累及大血管以及术前Hb<110g/L是术中输血的独立危险因素。在术后输血率、术后进入ICU率、住院时间以及出院Hb值4个预后指标上,术中输血组均弱于未输血组。结论对于存在术中输血高危因素的腹膜后肿瘤患者,应重点关注并提前干预,降低患者输血率,保障手术安全,改善患者预后。
Objective To analyze the influencing factors and prognosis of intraoperative blood transfusion in patients with retroperitoneal tumors. Methods Clinical data of 136 patients with retroperitoneal tumor surgery were retrospectively analyzed. χ~2 test was used to analyze the parameters of intraoperative blood transfusion group and non-transfusion group. The P<0.05 index was further included in multivariate logistic regression analysis. Prognostic factors of the 136 patients were compared between the two groups. Results Among patients in the intraoperative blood transfusion group and the non-transfusion group, liposarcoma was the most common histological type, accounting for 38.5% and 17.9%, respectively. Univariate analysis generated influence factors as follows: The composition ratio of liposarcoma, multiple operations, combined resection of organs, tumor involving large blood vessels, tumor length >10 cm, preoperative APTT>39 s, preoperative Hb<110 g/L. The differences were statistically significant(P<0.05). Multivariate logistic regression analysis showed that tumor length>10 cm, multiple operations, tumor involvement of large vessels and preoperative Hb<110 g/L were independent risk factors for intraoperative blood transfusion. The intraoperative blood transfusion group showed inferior data in the postoperative transfusion rate, postoperative ICU rate, hospital stay, and discharged Hb compared to the non-transfusion group. Conclusion Patients with retroperitoneal tumors with high risk factors for intraoperative blood transfusion deserve extra consideration to reduce the transfusion rate, ensuring the safety of surgery and improving prognosis.
Objective To analyze the influencing factors and prognosis of intraoperative blood transfusion in patients with retroperitoneal tumors. Methods Clinical data of 136 patients with retroperitoneal tumor surgery were retrospectively analyzed. χ~2 test was used to analyze the parameters of intraoperative blood transfusion group and non-transfusion group. The P<0.05 index was further included in multivariate logistic regression analysis. Prognostic factors of the 136 patients were compared between the two groups. Results Among patients in the intraoperative blood transfusion group and the non-transfusion group, liposarcoma was the most common histological type, accounting for 38.5% and 17.9%, respectively. Univariate analysis generated influence factors as follows: The composition ratio of liposarcoma, multiple operations, combined resection of organs, tumor involving large blood vessels, tumor length >10 cm, preoperative APTT>39 s, preoperative Hb<110 g/L. The differences were statistically significant(P<0.05). Multivariate logistic regression analysis showed that tumor length>10 cm, multiple operations, tumor involvement of large vessels and preoperative Hb<110 g/L were independent risk factors for intraoperative blood transfusion. The intraoperative blood transfusion group showed inferior data in the postoperative transfusion rate, postoperative ICU rate, hospital stay, and discharged Hb compared to the non-transfusion group. Conclusion Patients with retroperitoneal tumors with high risk factors for intraoperative blood transfusion deserve extra consideration to reduce the transfusion rate, ensuring the safety of surgery and improving prognosis.
引文
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[8] 马军,王杰军,张力,等.肿瘤相关性贫血临床实践指南(2015—2016版).中国实用内科杂志,2016,36(8):1-21.
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[10] Rineau E,Chaudet A,Chassier C,et al.Implementing a blood management protocol during the entire perioperative period allows a reduction in transfusion rate in major orthopedic surgery:a before-after study.Transfusion,2016,56(3):673-681.
[2] Gyorki DE,Brennan MF.Management of recurrent retroperitoneal sarcoma.J Surg Oncol,2014,109(1):53-59.
[3] Gemici K,Buldui,Acar T,et al.Management of patients with retroperitoneal tumors and a review of the literature.World J Surg Oncol.2015,13:143-150.
[4] Avances C,Mottet N,Mahatmat A,et al.Prognostic factors for first recurrence inpatients with retroperitoneal sarcoma.Urol Oncol,2006,24:94-96.
[5] Schwarzbach MH,Hormann Y,Hinz U,et al.Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement.J Vasc Surg,2006,44:46-55.
[6] 童汉兴,邵叶波,张勇.原发性腹膜后肿瘤外科诊疗中的难点聚焦.实用肿瘤杂志,2013,28(5):460-464.
[7] 孔祥骞,孔丙元,魏淑英.冷沉淀与机采血小板联合应用抢救大出血患者输注效果分析.临床输血与检验杂志,2012,14(4):340-342.
[8] 马军,王杰军,张力,等.肿瘤相关性贫血临床实践指南(2015—2016版).中国实用内科杂志,2016,36(8):1-21.
[9] Dunne JR,Malone D,Tracy JK,et al.Perioperative anemia:an independent risk factor for infection,mortality,and resource utilization in surgery.J Surg Res.2002,102(2):237-244.
[10] Rineau E,Chaudet A,Chassier C,et al.Implementing a blood management protocol during the entire perioperative period allows a reduction in transfusion rate in major orthopedic surgery:a before-after study.Transfusion,2016,56(3):673-681.