颅内动脉瘤手术中输血的相关因素

J. Yee, A. Koht, R. McCarthy, J. Bebawy
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引用次数: 1

摘要

本单中心回顾性观察性研究旨在确定颅内动脉瘤手术患者术中输血的相关危险因素。考虑到与血液制品输血相关的已知风险,一些组织现在有指导方针,建议对产品管理采取比过去更严格的方法。此外,颅内动脉瘤手术中输血的标准也没有很好的定义。这项研究的作者希望在这个特殊的病人群体和在更严格的输血模式时代确定输血的危险因素。使用多元二元logistic回归分析回顾性分析了2006年至2012年间在西北纪念医院(Chicago, illinois)连续接受颅内动脉瘤手术的470例患者的数据。在该队列中,有9.5%(470人中有46人)接受了术中红细胞(RBC)输注,术中输血患者的估计失血量中位数为500 mL(四分位数范围,275-1000 mL),输注红细胞单位中位数为2(四分位数范围,1-2),输注量中位数为750 mL(四分位数范围,375-750 mL)。术前输血相关危险因素与动脉瘤破裂高度相关(年龄较大[P < 0.001]、入院血红蛋白水平较低[P < 0.001]、术前破裂[P < 0.001]、HuntHess分级较高[P < 0.001])。术中输血的危险因素和独立预测因素包括动脉瘤较大(>10 mm;P = 0.03)、脑内血肿排出(P = 0.02)和脑室内出血(P < 0.001)。其中,本研究表明输血最重要的危险因素包括血红蛋白低于11.7 g/dL和年龄大于52岁。基于本研究结果,作者建议年龄大于52岁的血红蛋白低于11.7 g/dL和血红蛋白在11.7 - 14 g/dL之间的患者在颅内动脉瘤手术前应进行红细胞交叉配型,因为他们属于需要围手术期输血的高危人群。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors Associated With Blood Transfusion During Intracranial Aneurysm Surgery
This single-center retrospective observational study aimed to identify risk factors associated with intraoperative blood transfusions in patients undergoing intracranial aneurysm surgery. Considering known risks associated with blood product transfusion, several organizations now have guidelines that advise a more restrictive approach to product administration than in the past. In addition, criteria for transfusion in intracranial aneurysm surgery are not well defined. The authors of this study hoped to identify risk factors for transfusion in this particular patient population and in the era of more restrictive transfusion patterns. Data from 470 consecutive patients who underwent intracranial aneurysm surgery at Northwestern Memorial Hospital (Chicago, Ill) between 2006 and 2012 were analyzed retrospectively using a multivariate binary logistic regression analysis. In this cohort, 9.5% (46 of 470) received intraoperative red blood cell (RBC) transfusions, and the median estimated blood loss in patients who had an intraoperative transfusion was 500 mL (interquartile range, 275–1000 mL) The median number of RBC units transfused was 2 (interquartile range, 1–2), and the volume transfused was 750 mL (interquartile range, 375–750 mL). Preoperative risk factors associated with transfusions were highly related to aneurysm rupture (older age [P < 0.001], lower admission hemoglobin level [P < 0.001], preoperative rupture [P < 0.001], and higher HuntHess grade [P < 0.001]). Intraoperative risk factors and independent predictors of RBC transfusion included larger aneurysm size (>10 mm; P = 0.03), intracerebral hematoma evacuation (P = 0.02), and intraventricular hemorrhage (P < 0.001). Of these, this study demonstrated that the most significant risk factors for transfusion included presenting hemoglobin of less than 11.7 g/dL and age older than 52 years. Based on the findings of this study, the authors suggest that patients with a hemoglobin less than 11.7 g/dL and those with hemoglobin between 11.7 and 14 g/dL who are older than 52 years should be cross-matched for RBCs before intracranial aneurysm surgery because they fall within the high-risk category of requiring perioperative blood transfusion.
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