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Current Status and Characteristics of Perioperative Transfusion in Gynecologic Patients
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摘要:
目的 分析妇科围术期输血的现状及特点, 总结合理用血措施。 方法 回顾性分析2014年1月至10月在北京协和医院行妇科手术的病例, 统计其中围术期输血病例, 分析不同疾病、不同手术方式的输血情况及特点。2013年同期妇科手术和输血病例作为对照进行比较。 结果 2014年1月至10月妇科手术总量6203例, 其中围术期异体输血286例, 自体输血80例, 妇科手术异体输血率4.6%, 手术总量较2013年同期增加10.5%, 而输血率降低27.0%(P=0.001)。恶性肿瘤手术具有较高的输血率, 其中输血率最高的是卵巢癌肿瘤细胞减灭术及再次肿瘤细胞减灭术, 输血率达45.3%, 输血病例的平均输血量达6.7 U。腹腔镜手术的输血率普遍低于开腹手术。腹腔镜宫颈癌根治术的输血率为6.2%, 而开腹宫颈癌根治术则达到10.9%。自体输血主要用于宫外孕/黄体破裂内出血、子宫肌瘤/肌腺瘤剔除和开腹全子宫切除术, 其自体输血率分别为17.0%、5.2%和2.8%, 平均输血量分别为749、429和397 ml。 结论 2014年较2013年同期妇科手术总量增加, 但输血率下降, 选择恰当的手术方式, 积极开展微创手术, 合理进行自体输血, 是妇科围术期合理用血的主要措施。 Abstract:Objective To analyze the current status and characteristics of perioperative transfusion in patients undergoing gynecologic surgery and to explore the rational management of blood product use. Methods Clinical data of patients who underwent gynecologic surgery in Peking Union Medical College Hospital from January to October in 2014 were retrospectively reviewed. Those who received perioperative transfusion were analyzed to summarize the status and characteristics of transfusion for different diseases and surgical procedures. The data of patients in 2014 were compared with those of patients in the corresponding period of 2013. Results Altogether 6203 patients underwent gynecologic surgery in Peking Union Medical College Hospital from January to October in 2014, including 286 patients who had allogeneic transfusion during perioperative period, and 80 who had autologous transfusion. The total number of surgery in 2014 increased by 10.5% compared with the same period in 2013, while the allogeneic transfusion rate in 2014 (4.6%) decreased by 27% compared with the same period in 2013 (P=0.001). Operations for malignancies had higher transfusion rates than those for mild diseases. Cytoreductive surgery and re-cytoreductive surgery for ovarian cancer had the highest rate of transfusion (45.3%), and the average transfusion volume was 6.7 U. Laparoscopy had lower transfusion rate compared with laparotomy. In radical resection of cervical cancer, approach by laparoscopy had a lower rate of transfusion than by laparotomy (6.2% vs. 10.9%). Autologous transfusion was applied mainly in operations for ectopic pregnancy or internal bleeding due to rupture of corpus luteum, myomectomy and total hysterectomy, with autologous transfusion rates being 17.0%, 5.2%, and 2.8%, and average transfusion volume being 749, 429, and 397 ml, respectively. Conclusions Perioperative transfusion rate in 2014 was lower than in 2013 despite more gynecologic operations in 2014. Rational blood use in gynecologic patients can be managed by strategies including selection of appropriate surgery procedures, application of minimally invasive surgery, and proper use of autologous trasfusion. -
Key words:
- gynecology /
- perioperative period /
- transfusion /
- intraoperative autologous transfusion
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表 1 2013年与2014年1月至10月妇科围术期输血量及输血率比较
年份 妇科手术总例数 输血例数 输血率(%) 红细胞悬液(U) 血浆(ml) 血小板(U) 总量(U) 平均输血量(U) 2013 5614 353 6.3 1667 1411 38 2410.5 6.8 2014 6203 286 4.6 1147 794 16 1560.0 5.5 P值 - 0.001 0.001 0.023 0.011 0.246 0.017 0.135 
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表 2 2014年1月至10月妇科围术期异体输血率及输血病例平均输血量
手术方式 输血率
[%(输血人数/总数)]输血量
(U)平均
输血量
(U)卵巢癌肿瘤细胞减灭术/再
次肿瘤细胞减灭术45.3(144/318) 958 6.7 开腹子宫内膜癌分期术 11.1(6/ 54) 20 3.3 开腹全子宫切除术 10.9(42/385) 189 4.5 开腹宫颈癌根治术 10.9(5/ 46) 18 3.6 瘢痕妊娠/宫角妊娠清除
(腹腔镜/开腹)7.3(4/ 55) 16 4.0 开腹子宫肌瘤/子宫肌腺瘤/
病灶剔除6.4(15/233) 83 5.5 腹腔镜宫颈癌根治术 6.2(9/145) 41 4.6 开腹附件手术 3.4(3/ 87) 8 2.7 腹腔镜子宫内膜癌分期术 2.1(2/ 95) 8 4.0 腹腔镜检查/活检 2.0(8/406) 16 2.0 腹腔镜全子宫切除术 1.3(10/763) 35 3.5 腹腔镜子宫肌瘤/子宫肌腺
瘤/病灶剔除1.2(7/580) 22 3.1 腹腔镜附件手术 0.4(5/1183) 18 3.6 宫颈手术(锥切/截除/环
状电切)0.3(2/611) 8 4.0 宫腔镜手术 0(0/636) 0 0 阴式子宫切除/盆底手术 0(0/132) 0 0 其他 5.1(24/474) 120 5.0 总计 4.6(286/6203) 1560 5.5
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表 3 2014年1月至10月术中回收式自体输血分布
手术方式 手术例数 自体输血例数 平均输血量(U) 自体输血率(%) 异体输血率(%) 宫外孕/黄体破裂内出血 206 35 749 17.0 0.5 子宫肌瘤/肌腺瘤剔除 731 38 429 5.2 1.9 良性疾病开腹全子宫切除术 253 7 397 2.8 10.3
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