作者投稿
专家审稿
编辑办公
邮件订阅
RSS
A Longitudinal Study of Perioperative Allogeneic Red Blood Cell Transfusion among Patients Undergoing Thoracotomy for Lobectomy in China
-
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. -
Key words:
- transfusion /
- red blood cell /
- perioperative period /
- thoracotomy for lobectomy /
- China
作者贡献: 汤博负责数据分析与统计、撰写论文；徐宵寒参与研究设计、数据采集；张越伦参与数据分析、研究实施，指导论文修改；黄宇光参与研究设计、论文修改及结果解读。利益冲突: 无 -
表 1 混合效应Logistic回归模型估算不同年份间异体红细胞输注率变化[aOR(95% CI)]
年份 校正地区 校正地区、患者年龄及性别 2013年 1.45(1.20~1.75) 1.45(1.20~1.75) 2014年 1.07(0.89~1.30) 1.07(0.89~1.30) 2015年 0.84(0.70~1.02) 0.84(0.69~1.02) 2016年 0.83(0.68~1.01) 0.83(0.68~1.01) 2017年 0.82(0.67~1.00) 0.82(0.68~1.00) 2018年 1.12(0.84~1.48) 1.12(0.85~1.48) aOR：调整的比值比 
下载: 导出CSV
表 2 混合效应Logistic回归模型估算不同地区间异体红细胞输注率变化[aOR(95% CI)]
地区 校正年份 校正年份、患者年龄及性别 西北 2.75(2.20~3.43) 2.74(2.19~3.42) 华中 2.30(1.90~2.78) 2.28(1.88~2.75) 西南 1.90(1.57~2.30) 1.90(1.57~2.30) 华北 1.06(0.86~1.29) 1.06(0.86~1.29) 东北 0.64(0.52~0.79) 0.64(0.52~0.79) 华南 0.54(0.42~0.69) 0.54(0.42~0.69) 华东 0.23(0.19~0.29) 0.23(0.19~0.29) aOR：同表 1
下载: 导出CSV
-
[1] Nordestgaard AT, Rasmussen LS, Sillesen M, et al. Red blood cell transfusion in surgery: an observational study of the trends in the USA from 2011 to 2016[J]. Anaesthesia, 2020, 75: 455-463. doi: 10.1111/anae.14900 [2] Carson JL, Triulzi DJ, Ness PM. Indications for and Adverse Effects of Red-Cell Transfusion[J]. N Engl J Med, 2017, 377: 1261-1272. doi: 10.1056/NEJMra1612789 [3] Yuan Y, Zhang Y, Shen L, et al. Perioperative Allogeneic Red Blood Cell Transfusion and Wound Infections: An Observational Study[J]. Anesth Analg, 2020, 131: 1573-1581. doi: 10.1213/ANE.0000000000005122 [4] Desai N, Schofield N, Richards T. Perioperative Patient Blood Management to Improve Outcomes[J]. Anesth Analg, 2018, 127: 1211-1220. doi: 10.1213/ANE.0000000000002549 [5] 中华医学会麻醉学分会. 围术期输血指南(2014)[M]. 北京: 人民卫生出版社, 2014: 208-214. [6] von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies[J]. Lancet, 2007, 370: 1453-1457. doi: 10.1016/S0140-6736(07)61602-X [7] 中华人民共和国民政部. 全国行政区划信息查询平台[EB/OL ]. [2021-02-01]. http://xzqh.mca.gov.cn/map. [8] Yu X, Wang Z, Wang Y, et al. Cost-effectiveness comparison of routine transfusion with restrictive and liberal transfusion strategies for surgical patients in China[J]. Vox Sang, 2019, 114: 721-739. doi: 10.1111/vox.12817 [9] Ecker BL, Simmons KD, Zaheer S, et al. Blood Transfusion in Major Abdominal Surgery for Malignant Tumors: A Trend Analysis Using the National Surgical Quality Improvement Program[J]. JAMA Surg, 2016, 151: 518-525. doi: 10.1001/jamasurg.2015.5094 [10] Zuckerman J, Coburn N, Callum J, et al. Declining Use of Red Blood Cell Transfusions for Gastrointestinal Cancer Surgery: A Population-Based Analysis[J]. Ann Surg Oncol, 2021, 28: 29-38. doi: 10.1245/s10434-020-09291-y [11] Mazzeffi MA, See JM, Williams B, et al. Five-year trends in perioperative red blood cell transfusion from index cases in five surgical specialties: 2011 to 2015[J]. Transfusion, 2018, 58: 1271-1278. doi: 10.1111/trf.14559 [12] Brynolf A, Zhao J, Wikman A, et al. Patterns of red-cell transfusion use in obstetric practice in sweden 2003-2017: A nationwide study[J]. Vox Sang, 2021. doi: 10.1111/vox.13074. [13] Roberts N, James S, Delaney M, et al. The global need and availability of blood products: a modelling study[J]. Lancet Haematol, 2019, 6: e606-e615. doi: 10.1016/S2352-3026(19)30200-5 [14] Zhang R, Wu Z, Wang Z, et al. Current status of clinical transfusion practice in Sichuan, China: A cross-sectional survey[J]. Transfus Apher Sci, 2018, 57: 65-70. doi: 10.1016/j.transci.2017.12.001 [15] Yu X, Pang H, Xu Z, et al. Multicentre evaluation of perioperative red blood cells transfusions in China[J]. Br J Anaesth, 2014, 113: 1055-1056. doi: 10.1093/bja/aeu392 [16] Yu X, Chen W, Liu Z, et al. Safety and current status of blood transfusion in China: an update[J]. Lancet Haematol, 2016, 3: e60-e62. doi: 10.1016/S2352-3026(16)00010-7 [17] Kong Y, Wang X, Yin Y, et al. Appropriateness of red blood cell use in China in the last thirteen years: A systematic review[J]. Heliyon, 2019, 5: e1408. http://www.ncbi.nlm.nih.gov/pubmed/30976687 [18] 中华医学会麻醉学分会第27次全国麻醉学术年会. 输血与血液保护学组工作总结[EB/OL ]. [2021-02-01]. http://www.csahq.cn/council/detail_1230.html. [19] 中华人民共和国国家卫生健康委员会. 关于2017年全国血液安全技术核查情况的通报[EB/OL ]. [2021-02-01]. http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=77ba80726c694b188e617f0d43d23856. [20] Mueller MM, Van Remoortel H, Meybohm P, et al. Patient Blood Management: Recommendations From the 2018 Frankfurt Consensus Conference[J]. JAMA, 2019, 321: 983-997. doi: 10.1001/jama.2019.0554 [21] 徐宵寒, 虞雪融, 黄宇光. 围手术期限制性红细胞输注的研究进展与指南对比[J]. 中国医学科学院学报, 2019, 41: 541-547. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYKX201904016.htm Xu XH, Yu XR, Huang YG. Perioperative Restrictive Red Blood Cell Transfusion: Recent Advances in Research and Clinical Guidelines[J]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 2019, 41: 541-547. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYKX201904016.htm [22] 周宗科, 翁习生, 孙天胜, 等. 中国骨科手术加速康复——围术期血液管理专家共识[J]. 中华骨与关节外科杂志, 2017, 10: 1-7. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJW201701001.htm Zhou ZK, Weng XS, Sun TS, et al. Expert Consensus in Enhanced Recovery after Orthopedic Surgery in China: Perioperative Blood Management[J]. Zhonghua Gu Yu Guan Jie Wai Ke Za Zhi, 2017, 10: 1-7. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJW201701001.htm [23] 胡盛寿, 纪宏文, 孙寒松, 等. 心血管手术患者血液管理专家共识[J]. 中国输血杂志, 2018, 31: 321-325. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201804001.htm Hu ST, Ji HW, Sun HS, et al. Chinese Experts Consensus Statement on Patient Blood Management in Patients Undergoing Cardiovascular Surgery[J]. Zhongguo Shu Xue Za Zhi, 2018, 31: 321-325. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201804001.htm [24] 杨欣, 李艺, 狄文, 等. 妇科围手术期患者血液管理的专家共识[J]. 中国妇产科临床杂志, 2019, 20: 560-563. https://www.cnki.com.cn/Article/CJFDTOTAL-FKLC201906029.htm Yang X, Li Y, Di W, et al. Experts Consensus Statement on Patient Blood Management in Patients Undergoing Gynecological Surgery[J]. Zhongguo Fu Chan Ke Lin Chuang Za Zhi, 2019, 20: 560-563. https://www.cnki.com.cn/Article/CJFDTOTAL-FKLC201906029.htm -
点击查看大图
图(2) / 表(2)
计量
- 文章访问数: 241
- HTML全文浏览量: 116
- PDF下载量: 19
- 被引次数: 0
