基于倾向性评分匹配法综合评价贮存式自体输血在肺癌手术患者中的临床应用效果

目的:综合评价贮存式自体输血(preoperative autologous blood donation,PABD)在肺癌手术患者中的临床应用效果。方法:回顾性分析2018年08月至2020年05月在我院行肺癌根治手术的患者共415例。其中80例采用贮存式自体输血(PABD组),335例未采用(No-PABD组)。采用倾向性评分匹配功能进行匹配,比较匹配后的两组患者的术中出血量、术中异体血输注量、输血不良反应、术后胸腔引流量、围术期的血红蛋白(Hb)、血小板(PLT)变化情况等指标。结果:采用1∶1最邻近匹配法,经倾向性评分匹配后成功匹配80对患者。PABD组采血后Hb、红细胞(RBC)、红细胞压积(Hct)水平均低于采血前,差异有统计学意义(P<0.05);而PLT水平在采血前后无统计学差异(P>0.05)。两组患者在术后1、3、7天的Hb和PLT变化基本一致,差异无统计学意义(P>0.05)。PABD组术中出血量(474.9±325.9)mL vs(458.1±281.5)mL]、术后胸水引流量(873.0±360.3)mL vs(774.5±341.7)mL]及住院时间(9.4±3.3)d vs(9.8±2.6)d]与No-PABD组比较无明显差异(P>0.05)。而PABD组异体血输注量(4000 mL vs 8800 mL)、异体血输入率(8.8%vs 23.8%)及输血相关费用(189.5±92.2)元vs(337.8±426.8)元]均低于No-PABD组。结论:贮存式自体输血在肺癌手术患者中的临床应用是安全的,可以降低异体血输入率,减少输血相关费用。

Comprehensive evaluation of the clinical application of preoperative autologous blood donation in patients with lung cancer surgery based on propensity score matching method

Objective:To evaluate the clinical effect of preoperative autologous blood donation in patients with lung cancer surgery.Methods:A retrospective analysis was made of 415 patients with lung cancer undergoing radical surgery in our hospital from August 2018 to May 2020.Among them,80 cases were treated with preoperative autologous blood donation (PABD group),335 cases were not used (No-PABD group).The intraoperative blood loss,intraoperative blood transfusion volume,complication of blood transfusion,postoperative thoracic drainage volume,changes of Hb and PLT in perioperative period were compared between the two groups after matching by propensity score matching function.Results:80 pairs of patients were successfully matched with 1∶1 nearest neighbor matching method after propensity score matching.The levels of Hb,RBC and Hct in PABD group were significantly lower than those before blood donation（P＜0.05),while there was no significant difference in PLT level before and after autologous blood sampling(P>0.05).There was no significant difference in Hb and PLT between the two groups at 1,3,7 days after operation（P>0.05).There was no significant difference in intraoperative blood loss［（474.9±325.9）mL vs (458.1±281.5)mL］,postoperative pleural drainage［（873.0±360.3)mL vs (774.5±341.7)mL］ and hospital stay［（9.4±3.3)d vs (9.8±2.6)d］ in the PABD group compared with the No-PABD group（P＞0.05).However,the amount of allogeneic blood transfusion(4 000 mL vs 8 800 mL),the rate of allogeneic blood transfusion（8.8% vs 23.8%) and transfusion related costs［（189.5±92.2) yuan vs (337.8±426.8) yuan］ in PABD group were lower than those in No-PABD group.Conclusion:The clinical preoperative autologous blood donation in patients with lung cancer surgery is safe,which can reduce the rate of allogeneic blood transfusion and reduce the cost of blood transfusion.