术中自体血回收的骨科患者术后输注异体血的危险因素分析

发布时间：2018-02-26 03:19

本文关键词： 术中自体血回收异体输血危险因素　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究分析骨科手术中行自体血回收(IBS)的患者术后输注异体血的危险因素,为围术期输血提供有效依据。方法:选择遵义医学院附属医院2013年5月至2015年5月行骨科手术并应用IBS的成年患者279例进行回顾性数据采集。对行IBS的骨科患者术后需输注异体血的影响因素进行二分类Logistic回归分析,依据预测数据集P绘制ROC曲线并求出最佳临界值。预留38例行IBS的骨科患者的临床资料代入回归模型中,检验回归模型预测的准确率。结果:所选取的279例病患中,术后输注异体血的患者有83例(29.7%),平均输注RBC的量为(2.48±1.39)U。单因素分析结果显示:年龄、性别、ASA分级、术前血红蛋白数值、手术时间、回收血量、出血量和术后切口引流量这8个变量具有显著性差异(P0.05)。将无多重共线性的自变量纳入二分类Logistic回归方程,结果显示:年龄(OR=0.415,P=0.006)和术前血红蛋白数值(OR=0.532,P=0.022)为行IBS的骨科患者术后输注异体血的保护因素。ASA分级(OR=2.393,P=0.035)和术后切口引流量(OR=4.279,P=0.000)为行IBS的骨科患者术后输注异体血的危险因素。ROC曲线下面积为0.790,模型的预测准确率为81.58%。结论:本研究的回归模型对判断行IBS的骨科患者术后是否需要输注异体血有较高的准确率。行IBS的骨科患者术后仍然有较高的异体血输注率,因此不应过分的依赖IBS,围术期仍需从众多影响因素中去考虑和完善血液保护措施,从而真正降低异体输血的风险。
[Abstract]:Objective: to study the risk factors of transfusion of allogeneic blood in patients undergoing orthopedic surgery with autogenous blood recovery (IBS). Methods: 279 adult patients who underwent orthopedic surgery and IBS from May 2013 to May 2015 in the affiliated Hospital of Zunyi Medical College were selected for retrospective data collection. Orthopaedic patients undergoing IBS were selected. The factors influencing the transfusion of allogeneic blood were analyzed by two classification Logistic regression analysis. According to the predicted data set P, the ROC curve was drawn and the optimal critical value was obtained. The clinical data of 38 orthopaedic patients who had been reserved for IBS were added to the regression model to test the prediction accuracy of the regression model. Results: among the 279 selected patients, There were 83 patients with allogeneic blood transfusion after operation. The average volume of RBC infusion was 2.48 卤1.39U. The results of univariate analysis showed that age, sex, preoperative hemoglobin value, operation time, blood volume were recovered. There were significant differences between the eight variables of bleeding volume and incision drainage volume (P 0.05). The independent variables without multiple collinearity were included in the two-class Logistic regression equation. The results showed that the protective factors of postoperative transfusion of allogeneic blood in orthopaedic patients undergoing IBS were the age of ORA 0.415 / P0. 006) and preoperative hemoglobin value of 0.532P0. 022). ASA grade OR2. 393 P0. 035) and postoperative incision drainage volume were the risk factors of postoperative transfusion of allogeneic blood in orthopaedic patients undergoing IBS. (4. 279P0. 000) were the risk factors for postoperative transfusion of allogeneic blood in orthopedic patients undergoing IBS. The area under the curve is 0.790, and the prediction accuracy of the model is 81.58.Conclusion: the regression model of this study has a high accuracy in judging whether orthopaedic patients undergoing IBS need transfusion of allogeneic blood after operation. The orthopaedic patients undergoing IBS are still alive after operation. There is a high rate of allogeneic blood transfusion. Therefore, we should not rely too much on IBS. In order to reduce the risk of allogeneic blood transfusion, we should consider and improve the blood protection measures in perioperative period.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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