协和医学杂志

2016, v.7(05) 379-383

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用血量大于等于20U患者围术期血液管理
Perioperative Blood Management of Patients Using More Than or Equal to 20 Units of Blood

张娇;虞雪融;袁青;黄宇光;
ZHANG Jiao;YU Xue-rong;YUAN Qing;HUANG Yu-guang;Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

摘要(Abstract):

目的探讨手术相关用血量大于等于20 U患者围术期血液管理特点。方法收集并分析北京协和医院2015年度用血量大于等于20 U手术患者的围术期资料,比较未经历非计划二次手术和经历非计划二次手术患者的相关信息。结果共36例患者纳入研究,经历非计划二次手术患者(n=12)初次择期手术中失血量明显低于未经历非计划二次手术患者(n=24),分别为1300和3000 ml(P<0.05);但非计划二次手术相较于其初次择期手术美国麻醉医师协会(American Society of Anaesthesiology,ASA)分级明显增高,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级分别为0、0、4、8、0例和2、9、1、0、0例;术中出血量(分别为2250和1050 ml)和输血量(红细胞分别为8和1 U,血浆分别为400和100 ml)亦均明显增加(P均<0.05)。36例患者中18例并发术前贫血。结论对于手术难度大、风险高的患者,在充分评估术中出血风险的基础上,采取个体化治疗方案,纠正术前贫血,术中严密止血,加强围术期凝血功能检测,可降低非计划二次手术的发生率,改善患者结局。
Objective To investigate blood management in perioperative period for patients using more than or equal to 20 units of blood. Methods Surgical patients using ≥20 units of blood in 2015 in Peking Union Medical College Hospital were included. Records regarding their perioperative period were collected,analyzed,and compared between the patients not receiving unplanned secondary surgery and those who received unplanned secondary surgery. Results Thirty-six patients were enrolled. The blood loss during the first surgery was significantly lower in the patients who did have unplanned secondary surgery( n = 12) compared with those who did not( n = 24)( 1300 ml vs. 3000 ml,P < 0. 05). Patients had higher American Society of Anesthesiology( ASA) grade in the unplanned secondary surgery compared with the primary surgery,with the number of cases classified as grade Ⅰ-Ⅴ being 0,0,4,8,0 and 2,9,1,0,0,respectively. Additionally,the average intraoperative blood loss( 2250 ml vs. 1050 ml) and volume of blood transfusion( red blood cell,8 U vs. 1 U; plasma,400 ml vs. 100 ml) were higher in the unplanned secondary surgery than in the primary surgery( all P < 0. 05). Eighteen patients were complicated with anemia before surgery. Conclusions For patients at high risk and receiving complex surgery,individualized treatment plan,therapy for anemia before se-lective surgery,careful hemostasis during operation,and perioperative monitoring of coagulation function may reduce the need for unplanned secondary surgery and improve patient outcome.

关键词(KeyWords): 用血量大于等于20 U;围术期;血液管理;非计划二次手术
blood use ≥20 units;perioperative period;blood management;unplanned secondary surgery

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作者(Author): 张娇;虞雪融;袁青;黄宇光;
ZHANG Jiao;YU Xue-rong;YUAN Qing;HUANG Yu-guang;Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

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