刘志丽;刘昌伟;宋小军;陈宇;倪冷;曾嵘;邵江;李拥军;
LIU Zhi-li;LIU Chang-wei;SONG Xiao-jun;CHEN Yu;NI Leng;ZENG Rong;SHAO Jiang;LI Yong-jun;Department of Vascular Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

• 1:中国医学科学院北京协和医学院北京协和医院血管外科

摘要(Abstract)：

目的分析血管外科围术期用血现状及趋势并总结血液管理经验,以指导临床合理用血。方法回顾性分析2011年1月1日至2014年12月31日北京协和医院血管外科住院手术患者的临床用血资料,统计手术方式、输血例数、输血成分、输血量及人均输血量等指标。结果 3989例手术患者中,406例(10.18%)围术期接受输血治疗,其中229例输注异体血,80例输注自体血,97例同时输注异体血与自体血。成分输血率为100%。43.60%的患者输注自体血,自体输血量占总用血量的20.60%。2011年至2014年用血数据显示:随着血管外科手术量的增长及高难度手术的开展(与2011年相比,后3年手术量的增长率分别为6.66%、9.28%、25.13%),总用血量与人均用血量也有所增加(与2011年相比,后3年的总用血量增长率分别为3.07%、12.91%、21.72%,人均用血量增长率分别为10.43%、18.56%、27.81%),血浆总用量与人均用量增长较明显(2014年较2011年,血浆总用量与人均用量分别增长96.77%与9.83%),但随着4年来回收自体血输入率的波动性增长(分别为4.32%、4.22%、4.65%、4.53%),异体红细胞的输入率呈逐年下降趋势(分别为9.19%、7.52%、6.67%、6.31%)。结论更多采用成分输血及自体血液回输的合理围术期用血,可以在手术量逐年增长和手术难度增大的情况下有效降低异体红细胞的输入,并保证围术期患者的安全。
Objective To analyze the status quo and tendency of blood transfusion in vascular surgery and summarize the experiences of rational blood transfusion management in order to provide clinical guidance. Methods Hospitalized patients who underwent vascular surgery at Peking Union Medical College Hospital from January 1,2011 to December 31,2014 were enrolled. The records of blood transfusion,surgical procedures,transfusion case number,transfusion components,transfusion volume,and mean transfusion volume were retrospectively analyzed. Results Altogether 3989 surgical patients were included. Four hundred and six patients( 10. 18%)received blood transfusion in perioperative period,including 229 patients receiving allogeneic blood transfusion,80 patients receiving autologous blood transfusion,and 97 patients receiving both. The rate of blood component transfusion was 100%. 43. 60% of the patients received autologous blood transfusion,accounting for 20. 60% of the total blood transfusion amount. According to the records from 2011 to 2014,with the increase of quantity and difficulty of vascular surgery( compared with 2011,the growth rate of vascular surgeries in 2012,2013,and2014 were 6. 66%,9. 28%,and 25. 13%,respectively),the total and the mean transfusion volume increasedtoo( compared with 2011,the total blood transfusion volume in 2012,2013,and 2014 increased by 3. 07%,12. 91%,and 21. 72%,and the mean transfusion volume in 2012,2013,and 2014 increased by 10. 43%,18. 56%,and 27. 81%,respectively),especially the transfusion of fresh frozen plasma( FFP)( compared with2011,the total and mean transfusion volume of FFP in 2014 increased by 96. 77% and 9. 83%,respectively).However,the rate of allogeneic red blood cell transfusion declined year by year( 9. 19%,7. 52%,6. 67%,6. 31%),along with a fluctuating increase of salvaged autologous blood usage at the 4 years( 4. 32%,4. 22%,4. 65%,4. 53%). Conclusion Rational perioperative blood transfusion management with the using of blood component transfusion and autologous blood transfusion could effectively reduce the transfusion of allogeneic red blood cells and ensure perioperative patient safety,in the context of increasing quantity and difficulty of vascular surgery.

关键词(KeyWords)： 血液管理;血管外科;围术期;腔内介入;复合手术
blood transfusion management;vascular surgery;perioperative period;endovascular intervention;hybrid operation

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作者(Author): 刘志丽;刘昌伟;宋小军;陈宇;倪冷;曾嵘;邵江;李拥军;
LIU Zhi-li;LIU Chang-wei;SONG Xiao-jun;CHEN Yu;NI Leng;ZENG Rong;SHAO Jiang;LI Yong-jun;Department of Vascular Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

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参考文献(References)：

• [1]Liumbruno GM,Bennardello F,Lattanzio A,et al.Recommendations for the transfusion management of patients in the peri-operative period.I.The pre-operative period[J].Blood Transfus,2011,9:19-40.
• [2]Liumbruno GM,Bennardello F,Lattanzio A,et al.Recommendations for the transfusion management of patients in the peri-operative period.II.The intra-operative period[J].Blood Transfus,2011,9:189-217.
• [3]Shander A.Emerging risks and outcomes of blood transfusion in surgery[J].Semin Hematol,2004,41(1 Suppl 1):117-124.
• [4]Dasararaju R,Marques MB.Adverse effects of transfusion[J].Cancer Control,2015,22:16-25.
• [5]Santos AA,Silva JP,Silva LD,et al.Therapeutic options to minimize allogeneic blood transfusions and their adverse effects in cardiac surgery:A systematic review[J].Rev Bras Cir Cardiovasc,2014,29:606-621.
• [6]Goodnough LT,Shander AS.Patient blood management[J].Anesthesiology,2012,116:1367-1376.
• [7]刘燕,陈方祥,滕方,等.329例大量输血患者成分输血分析[J].重庆医学,2009,38:1433-1452.
• [8]周宏莉,李建春.自体和异体输血对严重创伤患者凝血功能的影响分析[J].国际检验医学,2012,33:2287-2288.
• [9]唐小斌,陈忠,王盛,等.腹主动脉瘤腔内修复与开放手术疗效比较[J].中华外科杂志,2009,47:661-663.
• [10]Eliason JL,Clouse WD.Current management of infrarenal abdominal aortic aneurysms[J].Surg Clin North Am,2007,87:1017-1033.
• [11]舒畅,王暾,黎明,等.“烟囱”技术在治疗累及主动脉弓分支动脉的Stanford B型主动脉夹层中的应用[J].中华医学杂志,2012,92:3320-3323.
• [12]Tadros RO,Faries PL,Ting W,et al.Update in the use of branched and fenestrated endografts to treat aortic aneurysms[J].Surg Techno Int,2014,24:273-279.
• [13]Schwierz E,Kolvenbach RR,Yoshida R,et al.Experience with the sandwich technique in endovascular thoracoabdominal aortic aneurysm repair[J].J Vas Surg,2014,59:1562-1569.
• [14]Ghoneim B,Elwan H,Eldaly W,et al.Management of critical lower limb ischemia in endovascular era:experience from511 patients[J].Int J Angiol,2014,23:197-206.
• [15]Zhou M,Huang D,Liu C,et al.Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease[J].Clin Interv Aging,2014,9:1595-1603.