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肺移植围手术期大量输血的危险因素及其预后分析

温焕舜 郝杨 陈静瑜 梁朝阳

温焕舜, 郝杨, 陈静瑜, 等. 肺移植围手术期大量输血的危险因素及其预后分析[J]. 器官移植, 2021, 12(2): 203-208. doi: 10.3969/j.issn.1674-7445.2021.02.011
引用本文: 温焕舜, 郝杨, 陈静瑜, 等. 肺移植围手术期大量输血的危险因素及其预后分析[J]. 器官移植, 2021, 12(2): 203-208. doi: 10.3969/j.issn.1674-7445.2021.02.011
Wen Huanshun, Hao Yang, Chen Jingyu, et al. Analysis of risk factors and clinical prognosis of massive blood transfusion during perioperative period of lung transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(2): 203-208. doi: 10.3969/j.issn.1674-7445.2021.02.011
Citation: Wen Huanshun, Hao Yang, Chen Jingyu, et al. Analysis of risk factors and clinical prognosis of massive blood transfusion during perioperative period of lung transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(2): 203-208. doi: 10.3969/j.issn.1674-7445.2021.02.011

肺移植围手术期大量输血的危险因素及其预后分析

doi: 10.3969/j.issn.1674-7445.2021.02.011
基金项目: 

国家自然科学基金 82070059

详细信息
    作者简介:

    温焕舜,男,1985年生,博士,主治医师,研究方向为肺移植与肺癌,Email:wenhuanshun@hotmail.com

    通讯作者:

    陈静瑜,男,1963年生,主任医师,研究方向为肺移植,Email:chenjy@wuxiph.com

    梁朝阳,男,1969年生,博士,主任医师,研究方向为肺移植与肺癌、食管癌,Email:chaoyangliang@hotmail.com

  • 中图分类号: R617, R457.1

Analysis of risk factors and clinical prognosis of massive blood transfusion during perioperative period of lung transplantation

More Information
  • 摘要:   目的  探讨肺移植围手术期大量输血的危险因素及其对预后的影响。  方法  回顾性分析159例肺移植受者的临床资料。根据围手术期输血量将受者分为大量输血组(20例)和非大量输血组(139例)。比较两组受者的临床资料,分析肺移植围手术期大量输血的危险因素,总结两组受者的预后情况。  结果  两组受者术前抗凝治疗、血红蛋白量、原发病为特发性肺纤维化或特发性肺动脉高压的例数,术中发现胸腔粘连例数、手术时间、各种成分输血量比较,差异均有统计学意义(均为P < 0.05)。术前抗凝治疗,术中发现胸腔粘连、使用体外膜肺氧合(ECMO)及手术时间长是肺移植围手术期大量输血的危险因素(均为P < 0.05)。大量输血组原发性移植物功能障碍(PGD)3级发生率和术后30 d内病死率均高于非大量输血组(均为P < 0.01)。体质量指数(BMI)低和大量输血是受者术后30 d内死亡的危险因素(P=0.048、P < 0.001)。大量输血组受者的1年生存率低于非大量输血组(P < 0.001)。  结论  术前抗凝治疗及术中发现胸腔粘连、使用ECMO和手术时间长是肺移植围手术期大量输血的危险因素,大量输血对受者预后有不良影响。

     

  • 图  1  两组受者肺移植术后的生存曲线

    Figure  1.  Survival curves of recipients after lung transplantation in two groups

    表  1  两组受者的临床资料比较

    Table  1.   Comparison of clinical data of recipients in two groups

    变量 大量输血组(n=20) 非大量输血组(n=139) P
    术前资料
       性别[n(%)] 0.992
          男 18(90) 125(90)
          女 2(10) 14(10)
       年龄[MQ25, Q75),岁] 58(40, 68) 57(30, 72) 0.455
       BMI[MQ25, Q75),kg/m2] 22(17, 25) 22(15, 30) 0.419
       抗凝治疗[n(%)] 6(30) 15(11) 0.018
       血红蛋白量(x±s, g/L) 135.9±1.9 125.1±5.2 0.025
       吸烟量[MQ25, Q75),支/年] 350(0, 1 000) 400(0, 2 000) 0.563
       原发病[n(%)]
          特发性肺纤维化 8(40) 89(64) 0.039
          慢性阻塞性肺疾病 2(10) 19(14) 0.650
          结缔组织病相关肺间质肺疾病 3(15) 11(8) 0.296
          支气管扩张 1(5) 6(4) 0.889
          特发性肺动脉高压 3(15) 2(1) 0.001
          外源性过敏性肺泡炎 1(5) 3(2) 0.448
          尘肺病 0(0) 3(2) 0.507
          肺纤维化合并肺气肿综合征 1(5) 2(1) 0.274
          闭塞性细支气管炎 1(5) 1(1) 0.108
    术中资料
       手术方式[n(%)] 0.105
          单肺移植 10(50) 95(68)
          双肺移植 10(50) 44(32)
       使用ECMO[n(%)] 19(95) 119(85) 0.246
          静脉-动脉 3(16) 9(8) 0.237
          静脉-静脉 16(84) 110(92)
       胸腔粘连[n(%)] 12(60) 43(31) 0.011
       手术时间[MQ25, Q75),min] 330(260, 430) 245(120, 450) 0.001
          单肺 310(260, 430) 210(120, 355) 0.001
          双肺 365(320, 390) 330(270, 450) 0.393
       输血量
          红细胞[MQ25, Q75),U] 13(10, 18) 0(0, 8) 0.001
          血浆[MQ25, Q75),mL] 2 000(1 200, 3 000) 400(0, 1 800) 0.001
          血小板[MQ25, Q75),U] 1(0, 3) 0(0, 1) 0.001
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出版历程
  • 收稿日期:  2020-11-16
  • 网络出版日期:  2021-03-19
  • 刊出日期:  2021-03-15

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