癌症患者手术备血策略和手术用血的危险因素分析

目的 探讨癌症患者的手术备血策略和影响手术用血的危险因素.方法 选择2012年1月至2014年1月,于东营鸿港医院择期手术的1 520例癌症患者的备血申请资料和550例癌症手术患者的用血资料为研究对象.回顾性分析癌症患者不同手术部位红细胞（RBC）和血浆的备血及用血情况,制定本院癌症手术患者的备血策略,并采用单因素分析及多因素非条件logistic回归分析,考察影响手术用血的危险因素.结果 本组癌症患者的手术输血率为36.2％（550/1 520）.多因素非条件logistic回归分析结果显示,癌症患者手术前的红细胞比容（Hct）（OR=2.301,95％CI：1.093～4.844,P=0.028）,血红蛋白（Hb）水平（OR=3.012,95％CI：1.203～7.541,P=0.019）,血小板（PLT）计数（OR=1.782,95％CI：1.194～2.660,P=0.005）,凝血酶原时间（PT） （OR=1.993,95％CI：1.002～3.887,P=0-042）及白蛋白（ALB）水平（OR=2.942,95％CI：1.101～7.861,P=0.031）是影响患者手术中输注RBC的危险因素;癌症患者手术前的Hct（OR=1.612,95％CI：1.189～2.185,P=0.002）,Hb浓度（OR=1.321,95％CI：1.634～1.068,P=0.010）,部分活化凝血酶原时间（APTT） （OR=2.911,95％CI：1.191～7.115,P=0.019）,ALB水平（OR=2.212,95％CI：1.231～3.975,P=0.008）,PT（OR=1.593,95％CI：1.229～2.065,P=0.004）及总蛋白（TP）水平（OR=1.193,95％CI：1.329～1.071,P=0.001）是影响患者手术中输注血浆的危险因素.结论 癌症患者手术备血,应充分考虑患者的个体情况,合理进行备血申请,输血应严格把握输血适应证,保证用血的科学性和安全性.

Study on Strategy of Blood Preparation and Risk Factors of Blood Using in Operation for Cancer Patients

Objective To explore the strategy of blood preparation for cancer surgical patients and risk factors of blood use in operation.Methods From January 2012 to January 2014,a total of 1 520 copies of blood preparation application data of cancer patients who needed operations and 550 copies of blood use data in operations of cancer patients in Honggang Hospital of Dongying,were included in this study.Preparation and use of red blood cell （RBC） and plasma in different surgical site of cancer patients were analyzed retrospectively,in order to develop strategies of blood preparation for cancer patients in our hospital.The univariate analysis and multifactor unconditioned logistic regression analysis methods were used to investigate the risk factors influenced blood use in operations.Results Transfusion rate of patients with cancer surgery was 36.2% （550/1 520）.Multifactor unconditioned logistic regression analysis results showed that patients＇ hematocrit （Hct） （OR =2.301,95% CI：1.093-4.844,P =0.028）,level of hemoglobin （Hb） （OR=3.012,95%CI：1.203-7.541,P=0.019）,plantlet （PLT） count （OR=1.782,95%CI：1.194-2.660,P=0.005）,prothrombin time （PT） （OR=1.993,95%CI：1.002-3.887,P=0-042） and level of albumin （ALB） （OR=2.942,95%CI：1.101-7.861,P=0.031） before operations were the risk factors of RBC transfusion in surgical cancer patients.Patients＇ Hct （OR=1.612,95%CI：1.189-2.185,P=0.002）,level of Hb （OR=1.321,95%CI：1.634-1.068,P=0.010）,activited partial thromboplastin time （APTT） （OR=2.911,95%CI：1.191-7.115,P=0.019）,level of ALB （OR=2.212,95%CI：1.231-3.975,P=0.008）,PT（OR=1.593,95%CI：1.229-2.065,P=0.004） and level of ALB （OR =1.193,95% CI：1.329-1.071,P =0.001） before operations were the risk factors of plasma transfusion in surgical cancer patients.Conclusions In blood preparation of cancer surgery,the patient＇s individual situation should be considered,apply blood preparation reasonable,and grasp the indications of blood transfusion