中国开胸肺叶切除术单病种患者围术期异体红细胞输注的纵向观察研究

汤博; 徐宵寒; 张越伦; 黄宇光

doi:10.12290/xhyxzz.2021-0140

中国开胸肺叶切除术单病种患者围术期异体红细胞输注的纵向观察研究

A Longitudinal Study of Perioperative Allogeneic Red Blood Cell Transfusion among Patients Undergoing Thoracotomy for Lobectomy in China

摘要

摘要:
目的探究围术期限制性输血策略实施前后我国行开胸肺叶切除术单病种患者异体红细胞输注情况变化。
方法本研究是一项基于人群横断面数据形成的纵向研究，数据来源于医院质量监测系统数据库，研究对象为数据库中2013年1月1日至2018年8月31日我国三级医院行开胸肺叶切除术的所有患者。主要观察指标为围术期异体红细胞输注率，并构建包含混合效应的Logistic回归模型分析不同年份、地区间异体红细胞输注率的变化。
结果共93 285例患者入选本研究。其中4367例(4.68%，95% CI：4.55%~4.82%)在围术期接受了异体红细胞输注。2013至2018年，异体红细胞年粗输注率分别为6.89%(95% CI：6.52%~7.29%)、5.23%(95% CI：4.93%~5.55%)、4.15%(95% CI：3.88%~4.44%)、4.32%(95% CI：4.03%~4.62%)、3.73%(95% CI：3.45%~4.03%)和4.37%(95% CI：3.49%~5.46%)。混合效应Logistic回归模型在校正地区、患者性别及年龄后，异体红细胞输注率整体呈下降趋势，但仍有小范围波动，以2017年最低(aOR=0.82，95% CI：0.68~1.00)，2018年稍有回升(aOR=1.12，95% CI：0.85~1.48)。异体红细胞输注率存在较大的地区差异，以西北地区最高(aOR=2.74，95% CI：2.19~3.42)，华东地区最低(aOR=0.23，95% CI：0.19~0.29)。
结论 2013至2018年，我国三级医院行开胸肺叶切除术单病种患者的围术期异体红细胞输注率明显下降，但存在显著的地区间差异。

Abstract:
Objective Restrictive transfusion strategy is recommended in "Perioperative Transfusion Guidelines (2014, China)" to limit the use of allogeneic red blood cell (RBC) transfusion. We aimed to examine whether the transfusion practice had changed.
Methods This study was a longitudinal population-based study. Using the database of Hospital Quality Monitoring System (HQMS), patients undergoing thoracotomy for lobectomy with or without lymph node dissection in tertiary hospitals between January 1st, 2013 and August 31st, 2018 in Mainland China were included. The main outcome was allogeneic RBC transfusion. The year- and area-specific crude prevalence and the age/sex-adjusted prevalence of allogeneic RBC transfusion with 95% confidence intervals (CI) were estimated using mixed-effects Logistic regression models.
Results A total of 93 285 patients were included, and 4367 (4.68%, 95% CI: 4.55%-4.82%) patients received allogeneic RBC transfusion. The yearly crude prevalence of RBC transfusion from 2013 to 2018 were 6.89% (95% CI: 6.52%-7.29%), 5.23% (95% CI: 4.93%-5.55%), 4.15% (95% CI: 3.88%-4.44%), 4.32% (95% CI: 4.03%-4.62%), 3.73% (95% CI: 3.45%-4.03%), and 4.37% (95% CI: 3.49%-5.46%), respectively. After adjusting to age, sex and area, a decline in the prevalence of allogeneic RBC transfusion was observed over time. The prevalence was lowest and below the average level in 2017 (aOR=0.82, 95% CI: 0.68-1.00) while rose a bit in 2018 (aOR=1.12, 95% CI: 0.85-1.48). Geographically, the prevalence of allogeneic RBC transfusion showed wide variability. At the regional level, the prevalence was highest in Northwest China (aOR=2.74, 95% CI: 2.19-3.42) and lowest in Eastern China (aOR=0.23, 95% CI: 0.19-0.29).
Conclusion From 2013 to 2018, a decrease in the proportion of patients exposed to allogeneic RBC transfusion in perioperative care of thoracotomy for lobectomy was observed after the implementation of restrictive transfusion strategy in China. Extensive geographic variability in the prevalence of perioperative transfusion existed among patients.

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