非体外循环冠状动脉旁路移植术围术期红细胞输血危险因素分析
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摘要
目的:分析非体外循环冠状动脉旁路移植术(OPCAB)围术期红细胞输血的危险因素并探讨大量输血的相关因素。方法:选取2013年2月至2017年10月在我院接受单纯OPCAB治疗的1 257例患者,根据输血情况分为输血组603例,其中少量输血(≤4 U)471例、大量输血(>4 U)132例,未输血组654例。采用单因素和多因素Logistic回归分析与OPCAB围术期红细胞输血及大量输血相关的因素。结果:OPCAB围术期红细胞输血比例为47.97%(603/1 257)。输血组与未输血组患者年龄、性别、体重指数(BMI)、吸烟史、慢性心力衰竭、术前静脉应用儿茶酚胺类药物和硝酸酯类药物的差异均有统计学意义(P均<0.05)。多因素Logistic回归分析结果显示,BMI(OR=0.902,95%CI:0.867~0.937,P<0.001)、女性(OR=1.562,95%CI:1.344~1.817,P<0.001)、年龄(OR=1.025,95%CI:1.007~1.044,P=0.008)、术前静脉应用儿茶酚胺类药物(OR=9.051,95%CI:1.037~78.979,P=0.046)和硝酸酯类药物(OR=1.359,95%CI:1.057~1.747,P=0.017)是OPCAB围术期红细胞输血独立危险因素。BMI(OR=0.875,95%CI:0.819~0.935,P<0.001)、年龄(OR=1.031,95%CI:1.005~1.059,P=0.021)、术前静脉应用硝酸酯脂类药物(OR=1.771,95%CI:1.175~2.669,P=0.006)和儿茶酚胺类药物(OR=11.381,95%CI:2.050~63.193,P=0.005)与大量输血独立相关。结论:年龄、女性、低BMI、术前静脉应用硝酸酯类药物或儿茶酚胺类药物是OPCAB围术期红细胞输血危险因素;除女性因素,其余均与大量输血相关。
Objectives: To analyze the risk factors of perioperative red blood cell transfusion in patients undergoing off-pump coronary artery bypass grafting(OPCAB), and explore the factors related to massive red blood cell transfusions.Methods: Data from 1 257 patients underwent off-pump coronary artery bypass grafting(CABG) in People's Hospital of Zhengzhou University from Feb. 2013 to Oct. 2017 were analyzed. Patients were divided into transfusion group(603 cases) and non-transfusion group(654 cases). Patients in transfusion group were further divided into small amount of blood transfusion subgroup(< 4 U, n=471) and large amount of blood transfusion subgroup(> 4 U, n=132). Factors associated with perioperative red blood cell transfusion and massive transfusion were analyzed by single factor analysis and logistic regression.Results: Prevalence of perioperative red blood cell transfusion during peri-OPCAB was 47.97%(603/1 257), there were significant differences in age, gender, BMI, smoking history, congestive heart failure, preoperative intravenous application of catecholamines and nitrates between transfusion group and non-transfusion group(all P<0.05). Multivariate logistic regression analysis indicated that BMI(OR=0.902, 95%CI 0.867-0.937, P<0.001), female(OR=1.562, 95%CI 1.344-1.817,P<0.001), age(OR=1.025, 95%CI 1.007-1.044, P=0.008), preoperative intravenous application of catecholamines(within 48 h, OR=9.051, 95%CI 1.037-78.979, P=0.046) and nitrates(within 24 h, OR=1.359, 95%CI 1.057-1.747, P=0.017) were the risk factors of perioperative red blood cell transfusion in the peri-OPCAB period; BMI(OR=0.875, 95%CI 0.819-0.935, P<0.001), age(OR=1.031, 95%CI 1.005-1.059, P=0.021), preoperative intravenous application of catecholamines(OR=1.771, 95%CI 1.175-2.669, P=0.006) and nitrates(OR=11.381, 95%CI 2.050-63.193, P=0.005) were risk factors associated with massive transfusions.Conclusions: Age, female gender, low BMI, preoperative intravenous application of nitroglycerin and catecholamine drugs are risk factors of perioperative red blood cell transfusion in patients undergoing OPCAB. Except female gender, the rest factors are also related to massive transfusions in patients undergoing OPCAB.
Objectives: To analyze the risk factors of perioperative red blood cell transfusion in patients undergoing off-pump coronary artery bypass grafting(OPCAB), and explore the factors related to massive red blood cell transfusions.Methods: Data from 1 257 patients underwent off-pump coronary artery bypass grafting(CABG) in People's Hospital of Zhengzhou University from Feb. 2013 to Oct. 2017 were analyzed. Patients were divided into transfusion group(603 cases) and non-transfusion group(654 cases). Patients in transfusion group were further divided into small amount of blood transfusion subgroup(< 4 U, n=471) and large amount of blood transfusion subgroup(> 4 U, n=132). Factors associated with perioperative red blood cell transfusion and massive transfusion were analyzed by single factor analysis and logistic regression.Results: Prevalence of perioperative red blood cell transfusion during peri-OPCAB was 47.97%(603/1 257), there were significant differences in age, gender, BMI, smoking history, congestive heart failure, preoperative intravenous application of catecholamines and nitrates between transfusion group and non-transfusion group(all P<0.05). Multivariate logistic regression analysis indicated that BMI(OR=0.902, 95%CI 0.867-0.937, P<0.001), female(OR=1.562, 95%CI 1.344-1.817,P<0.001), age(OR=1.025, 95%CI 1.007-1.044, P=0.008), preoperative intravenous application of catecholamines(within 48 h, OR=9.051, 95%CI 1.037-78.979, P=0.046) and nitrates(within 24 h, OR=1.359, 95%CI 1.057-1.747, P=0.017) were the risk factors of perioperative red blood cell transfusion in the peri-OPCAB period; BMI(OR=0.875, 95%CI 0.819-0.935, P<0.001), age(OR=1.031, 95%CI 1.005-1.059, P=0.021), preoperative intravenous application of catecholamines(OR=1.771, 95%CI 1.175-2.669, P=0.006) and nitrates(OR=11.381, 95%CI 2.050-63.193, P=0.005) were risk factors associated with massive transfusions.Conclusions: Age, female gender, low BMI, preoperative intravenous application of nitroglycerin and catecholamine drugs are risk factors of perioperative red blood cell transfusion in patients undergoing OPCAB. Except female gender, the rest factors are also related to massive transfusions in patients undergoing OPCAB.
引文
[1] Kinnunen EM, Zanobini M, Onorati F, et al. The impact of minor blood transfusion on the outcome after coronary artery bypass grafting[J]. J Crit Care, 2017, 8(40):207-212. DOI:10.1016/j.jcrc.2017.04.025.
[2]吴慧,胡盛寿,郑哲,等.围术期输血与冠状动脉旁路移植术近远期临床结果的相关性[J].中国全科医学,2013, 16(10):3554-3558.DOI:10.3969/j.issn.1007-9572.2013.10.083.
[3]周玉姣,于坤.体外循环红细胞损伤的原因、表现及危害[J].中国体外循环杂志,2015,3(13):61-64. DOI:10.13498/j.cnki.chin.j.ecc.2015.01.18.
[4]陈良,吕琳,楼松,等.冠状动脉旁路移植术患者围术期输血的危险因素评估[J].中国胸心外科临床杂志,2016, 7(23):653-657.DOI:10.7507/1007-4848.20160158.
[5] Mariscalco G, Biancari F, Juvonen T, et al. Red blood cell transfusion is a determinant of neurological complications after cardiac surgery[J]. Interact Cardiovasc Thorac Surg, 2015,20(2):166-171. DOI:10.1093/icvts/ivu360.
[6] Likosky DS, Paone G, Zhang M, et al. Red blood cell transfusions impact pneumonia rates after coronary artery bypass grafting surgery[J]. Ann Thorac Surg, 2015, 100(3):794-801. DOI:10.1016/j.athoracsur.2015.03.089.
[7] Engoren M, Scwann TA, Habib RH, et al. The independent effects of anemia and transfusion on mortality after coronary artery bypass[J]. Ann Thorac Surg, 2014, 97(2):514-520. DOI:10.1016/j.athoracsur.2013.09.019.
[8] Paone G, Likosky DS, Brewer R, et al. Transfusion of 1 and 2units of red blood cells is associated with increased morbidity and mortality[J]. Ann Thorac Surg, 2014, 97(1):87-94. DOI:10.1016/j.athoracsur.2013.07.020.
[9] Kowalewski M, Pawliszak W, Malvindi PG, et al. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting:meta-analysis[J]. J Thorac Cardiovasc Surg, 2016, 151(1):60-77.DOI:10.1016/j.jtcvs.2015.08.042.
[10] Ng RRG, Chew STH, Liu W, et al. The inflammatory response between miniaturised and conventional cardiopulmonary bypass after cardiac surgery in an Asian population[J]. Perfusion, 2015, 30(6):487-494.DOI:10.1177/0267659114563779.
[11] Gaudriot B, Uhel F, Gregoire M, et al. Immune dysfunction after cardiac surgery with cardiopulmonary bypass:beneficial effects of maintaining mechanical ventilation[J]. Shock, 2015, 44(3):228-233.DOI:10.1097/SHK.0000000000000416.
[12] Shehata N, Naglie G, Alghamdi AA, et al. Risk factors for red cell transfusion in adults undergoing coronary artery bypass surgery:a systermatic review[J]. Vox Sang, 2007, 93(1):1-11. DOI:10.1111/j.1423-0410.2007.00924.x.
[13]吴慧,胡盛寿,郑哲,等.单纯冠状动脉旁路移植术患者围术期输血的危险因素分析[J].中国输血杂志,2012,25(4):336-340.DOI:10.13303/j.cjbt.issn.1004-549x.2012.04.035.
[14] Sa MP, Soares EF, Santos CA, et al. Predictors of transfusion of packed red blood cells in coronary artery bypass grafting surgery[J].Rev Bras Cir Cardiovasc, 2011, 26(4):552-558. DOI:10.5935/1678-9741.20110044.
[15]张健瑜,梁茜,许兆延.冠状动脉微循环障碍的研究现状及性别差异[J].中国动脉硬化杂志,2017, 25(8):850-855.DOI:10.3969/j.issn. 1007-3949.2017.08.017.
[16]张运,陈韵岱,傅向华,等.冠状动脉微血管疾病诊断和治疗的中国专家共识[J].中国循环杂志,2017, 32(5):421-430. DOI:10.3969/j.issn. 10070-3614.2017.05.003.
[17] Malenica M, Prnjavorac B, Bego T, et al. Effect of cigarette smoking on haematological parameters in healthy population[J]. Med Arch, 2017,71(2):132-136. DOI:10.5455/medarh.2017.71.132-136.
[18] Calapai G, Caputi AP, Mannucci C, et al. Cardiovascular biomarkers in groups of established smokers after a decade of smoking[J]. Basic Clin Pharmacol Toxicol, 2009, 104(4):322-328. DOI:10.1111/j.1742-7843.2008.00361.x.
[2]吴慧,胡盛寿,郑哲,等.围术期输血与冠状动脉旁路移植术近远期临床结果的相关性[J].中国全科医学,2013, 16(10):3554-3558.DOI:10.3969/j.issn.1007-9572.2013.10.083.
[3]周玉姣,于坤.体外循环红细胞损伤的原因、表现及危害[J].中国体外循环杂志,2015,3(13):61-64. DOI:10.13498/j.cnki.chin.j.ecc.2015.01.18.
[4]陈良,吕琳,楼松,等.冠状动脉旁路移植术患者围术期输血的危险因素评估[J].中国胸心外科临床杂志,2016, 7(23):653-657.DOI:10.7507/1007-4848.20160158.
[5] Mariscalco G, Biancari F, Juvonen T, et al. Red blood cell transfusion is a determinant of neurological complications after cardiac surgery[J]. Interact Cardiovasc Thorac Surg, 2015,20(2):166-171. DOI:10.1093/icvts/ivu360.
[6] Likosky DS, Paone G, Zhang M, et al. Red blood cell transfusions impact pneumonia rates after coronary artery bypass grafting surgery[J]. Ann Thorac Surg, 2015, 100(3):794-801. DOI:10.1016/j.athoracsur.2015.03.089.
[7] Engoren M, Scwann TA, Habib RH, et al. The independent effects of anemia and transfusion on mortality after coronary artery bypass[J]. Ann Thorac Surg, 2014, 97(2):514-520. DOI:10.1016/j.athoracsur.2013.09.019.
[8] Paone G, Likosky DS, Brewer R, et al. Transfusion of 1 and 2units of red blood cells is associated with increased morbidity and mortality[J]. Ann Thorac Surg, 2014, 97(1):87-94. DOI:10.1016/j.athoracsur.2013.07.020.
[9] Kowalewski M, Pawliszak W, Malvindi PG, et al. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting:meta-analysis[J]. J Thorac Cardiovasc Surg, 2016, 151(1):60-77.DOI:10.1016/j.jtcvs.2015.08.042.
[10] Ng RRG, Chew STH, Liu W, et al. The inflammatory response between miniaturised and conventional cardiopulmonary bypass after cardiac surgery in an Asian population[J]. Perfusion, 2015, 30(6):487-494.DOI:10.1177/0267659114563779.
[11] Gaudriot B, Uhel F, Gregoire M, et al. Immune dysfunction after cardiac surgery with cardiopulmonary bypass:beneficial effects of maintaining mechanical ventilation[J]. Shock, 2015, 44(3):228-233.DOI:10.1097/SHK.0000000000000416.
[12] Shehata N, Naglie G, Alghamdi AA, et al. Risk factors for red cell transfusion in adults undergoing coronary artery bypass surgery:a systermatic review[J]. Vox Sang, 2007, 93(1):1-11. DOI:10.1111/j.1423-0410.2007.00924.x.
[13]吴慧,胡盛寿,郑哲,等.单纯冠状动脉旁路移植术患者围术期输血的危险因素分析[J].中国输血杂志,2012,25(4):336-340.DOI:10.13303/j.cjbt.issn.1004-549x.2012.04.035.
[14] Sa MP, Soares EF, Santos CA, et al. Predictors of transfusion of packed red blood cells in coronary artery bypass grafting surgery[J].Rev Bras Cir Cardiovasc, 2011, 26(4):552-558. DOI:10.5935/1678-9741.20110044.
[15]张健瑜,梁茜,许兆延.冠状动脉微循环障碍的研究现状及性别差异[J].中国动脉硬化杂志,2017, 25(8):850-855.DOI:10.3969/j.issn. 1007-3949.2017.08.017.
[16]张运,陈韵岱,傅向华,等.冠状动脉微血管疾病诊断和治疗的中国专家共识[J].中国循环杂志,2017, 32(5):421-430. DOI:10.3969/j.issn. 10070-3614.2017.05.003.
[17] Malenica M, Prnjavorac B, Bego T, et al. Effect of cigarette smoking on haematological parameters in healthy population[J]. Med Arch, 2017,71(2):132-136. DOI:10.5455/medarh.2017.71.132-136.
[18] Calapai G, Caputi AP, Mannucci C, et al. Cardiovascular biomarkers in groups of established smokers after a decade of smoking[J]. Basic Clin Pharmacol Toxicol, 2009, 104(4):322-328. DOI:10.1111/j.1742-7843.2008.00361.x.