自体输血对创伤性颅脑损伤患者术后并发症及转归的影响

发布时间：2018-03-09 03:33

本文选题：输血治疗　切入点：回收式自体输血　出处：《临床麻醉学杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的探讨术中回收式自体输血与异体输血对创伤性颅脑损伤患者行开颅手术后并发症及转归的影响。方法回顾性分析我院2012年1月至2016年6月行急诊开颅手术的创伤性颅脑损伤患者199例,男161例,女38例,ASAⅠ~Ⅳ级,按是否使用自体输血分为自体血组(n=108)和异体血组(n=91)。均采用限制性输血策略,术中及术后通过回输自体血和/或输注RBC以维持Hb 70~100g/L。记录手术后并发症和输血不良反应,并根据格拉斯哥预后评分(Glasgow outcome score,GOS)判断患者临床转归情况。结果自体血组术后并发症发生率明显低于异体血组(33%vs.56%,P0.01),输血不良反应发生率明显低于异体血组(5%vs.14%,P0.05),GOS=4分的比例明显高于异体血组(P0.01)。Logistic回归分析显示异体输血是术后并发症的独立危险因素(OR=1.953,95%CI1.381~2.529)。结论自体输血能减少创伤性颅脑损伤患者手术后并发症发生率,降低输血风险,改善患者的临床转归。
[Abstract]:Objective to investigate the effect on prognosis of patients with traumatic brain injury after craniotomy and complications of intraoperative autotransfusion and homologous blood transfusion during surgery. Methods a retrospective analysis of 199 patients with traumatic brain injury in our hospital from January 2012 to June 2016 for emergency craniotomy patients, 161 cases were male, 38 were female, ASA I ~ IV, according to whether or not to use autologous blood transfusion is divided into autologous blood group (n=108) and allogeneic blood group (n=91). Using the limited blood transfusion strategy, intraoperative and postoperative blood transfusion by autologous and / or infusion of RBC Hb 70~100g/L. in order to maintain records of postoperative complications and blood transfusion adverse reactions, and according to the Glasgow outcome score (Glasgow outcome score. GOS) determine the clinical outcome in patients. The incidence rate of complications was significantly lower than that of allogeneic blood group results of autologous blood group (33%vs.56%, P0.01), the adverse reaction rate of blood transfusion was significantly lower than that of allogeneic blood group (5% vs.14%, P0.05, GOS=4) The ratio was significantly higher than that of allogeneic blood group (P0.01).Logistic regression analysis showed that blood transfusion is an independent risk factor of postoperative complications (OR=1.953,95%CI1.381~2.529). Conclusion autologous blood transfusion can reduce the incidence of traumatic brain injury patients with postoperative complications, reduce the blood transfusion risk, improve the clinical outcomes of patients.

【作者单位】：广西医科大学第三附属医院麻醉科;广西医科大学第三附属医院神经外科;
【基金】：广西南宁科技攻关项目(20123240) 广西临床重点专科建设资金资助(桂卫医发〔2016〕2号)
【分类号】：R614

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