全子宫切除术患者围手术期输血研究

目的分析全子宫切除术患者围手术期影响输血的相关因素,探讨减少异体血输注的有效措施,并为建立全子宫切除术单病种临床输血评价考核指标提供依据。方法选取大连地区3家三级甲等综合医院和1家妇幼保健院接受全子宫切除术患者747例,分为输血组(69例)和未输血组(678例);收集747例全子宫切除术患者的基本信息、手术相关信息、术前血常规、术后转归情况、围手术期输血量,进行统计学分析。结果全子宫切除术患者围手术期输血比例为9.2%(69/747),人均红细胞用血量(0.4±2.1)U。输血组和未输血组在年龄、手术时间、术中失血量、术前Hb浓度、住院天数、抗生素使用种类和天数方面的差异P<0.05,均有统计学意义,数值分别为(49.7±9.1)和(53±9.5)岁、(182.7±83.5)和(119.5±64.8)min、(603±650)和(160±173)mL、(96±26)和(124±18)g/L、(9.3±4.8)和(7.3±3.9)d、(2.2±1.1)和(1.6±0.7)种、(6.0±3.9)和(4.4±2.2)d。患者围手术期输血量与术中失血量、手术时间和术前Hb浓度显著相关,相关系数分别为0.004、0.002、-0.022。结论应加强全子宫切除术的患者血液管理,通过提高术前Hb水平、减少手术时间和术中失血量来降低异体血的输注,改善患者预后。

Perioperative blood transfusionfor patients undergoing totalhysterectomy

Objective To analyze the related factors affecting perioperative blood transfusionin patients undergoing totalhysterectomy, explorethe effective measures to reduce allogeneic blood transfusion and provide data for the establishment of clinical blood transfusion single-disease evaluation index of total hysterectomy. Methods 747 cases of total hysterectomy from three grade-A tertiary general hospitals and onematernal and child health care hospitalin Dalian wereselected, and divided into transfusion group(n=69)and non-transfusion(n=678). Detailed information was collected and analyzed, including patient demographics, operation information,blood routine before operation, postoperative recovery and transfusion volume.Results 9.2%(69/747)of total hysterectomy patients received blood transfusion, with per capita red blood usageof(0.4±2.1)U. The age, operative time, volume of intra-operationbleeding,pre-operationhemoglobin(Hb) level,length ofhospital stay, types and days of antibiotics use between transfusion group and non-transfusion groupwere(49.7±9.1)vs(53±9.5)years old,(182.7±83.5)vs(119.5±64.8)min,(603±650)vs(160±173)mL,(96±26)vs(124±18)g/L,(9.3±4.8)vs(7.3±3.9)days,(2.2±1.1)vs(1.6±0.7)kinds,(6.0±3.9)vs(4.4±2.2)days, respectively, showing significant differences(P<0.05). Transfusion volumewas associated with volume of intra-operation bleeding(r=0.004), operative time(r=0.002) and Hb level of pre-operation(r=-0.022).Conclusion Blood management of patients undergoingtotal hysterectomy should be strengthened to reduce the incidence of allogeneic blood transfusion and improve patient outcomes by raising the pre-operation Hb level,shortening the operative time and reducing the volume of intra-operation bleeding.