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摘要:
目的 分析血管外科围术期用血现状及趋势并总结血液管理经验, 以指导临床合理用血。 方法 回顾性分析2011年1月1日至2014年12月31日北京协和医院血管外科住院手术患者的临床用血资料, 统计手术方式、输血例数、输血成分、输血量及人均输血量等指标。 结果 3989例手术患者中, 406例(10.18%)围术期接受输血治疗, 其中229例输注异体血, 80例输注自体血, 97例同时输注异体血与自体血。成分输血率为100%。43.60%的患者输注自体血, 自体输血量占总用血量的20.60%。2011年至2014年用血数据显示:随着血管外科手术量的增长及高难度手术的开展(与2011年相比, 后3年手术量的增长率分别为6.66%、9.28%、25.13%), 总用血量与人均用血量也有所增加(与2011年相比, 后3年的总用血量增长率分别为3.07%、12.91%、21.72%, 人均用血量增长率分别为10.43%、18.56%、27.81%), 血浆总用量与人均用量增长较明显(2014年较2011年, 血浆总用量与人均用量分别增长96.77%与9.83%), 但随着4年来回收自体血输入率的波动性增长(分别为4.32%、4.22%、4.65%、4.53%), 异体红细胞的输入率呈逐年下降趋势(分别为9.19%、7.52%、6.67%、6.31%)。 结论 更多采用成分输血及自体血液回输的合理围术期用血, 可以在手术量逐年增长和手术难度增大的情况下有效降低异体红细胞的输入, 并保证围术期患者的安全。 Abstract:Objective To analyze the status quo and tendency of blood transfusion in vascular surgery and summarize the experiences of rational blood transfusion management in order to provide clinical guidance. Methods Hospitalized patients who underwent vascular surgery at Peking Union Medical College Hospital from January 1, 2011 to December 31, 2014 were enrolled. The records of blood transfusion, surgical procedures, transfusion case number, transfusion components, transfusion volume, and mean transfusion volume were retrospectively analyzed. Results Altogether 3989 surgical patients were included. Four hundred and six patients (10.18%) received blood transfusion in perioperative period, including 229 patients receiving allogeneic blood transfusion, 80 patients receiving autologous blood transfusion, and 97 patients receiving both. The rate of blood component transfusion was 100%. 43.60% of the patients received autologous blood transfusion, accounting for 20.60% of the total blood transfusion amount. According to the records from 2011 to 2014, with the increase of quantity and difficulty of vascular surgery (compared with 2011, the growth rate of vascular surgeries in 2012, 2013, and 2014 were 6.66%, 9.28%, and 25.13%, respectively), the total and the mean transfusion volume increased too (compared with 2011, the total blood transfusion volume in 2012, 2013, and 2014 increased by 3.07%, 12.91%, and 21.72%, and the mean transfusion volume in 2012, 2013, and 2014 increased by 10.43%, 18.56%, and 27.81%, respectively), especially the transfusion of fresh frozen plasma (FFP) (compared with 2011, the total and mean transfusion volume of FFP in 2014 increased by 96.77% and 9.83%, respectively). However, the rate of allogeneic red blood cell transfusion declined year by year (9.19%, 7.52%, 6.67%, 6.31%), along with a fluctuating increase of salvaged autologous blood usage at the 4 years(4.32%, 4.22%, 4.65%, 4.53%). Conclusion Rational perioperative blood transfusion management with the using of blood component transfusion and autologous blood transfusion could effectively reduce the transfusion of allogeneic red blood cells and ensure perioperative patient safety, in the context of increasing quantity and difficulty of vascular surgery. -
表 1 2011—2014年血管外科手术患者手术量与输血例数
年份 手术患者例数 手术例数 输血例数 输血率*(%) 2011 903 991 107 11.84 2012 971 1057 99 10.20 2013 990 1083 100 10.10 2014 1125 1240 100 8.89 合计 3989 4371 406 10.18 *输血率=输血例数/手术患者例数 
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表 2 2011—2014年血管外科手术患者临床成分输血情况
年份 手术
患者例数红细胞 血浆 回收自体血 输入
例数输入率
(%)输入量
(U)人均量
(U)输入
例数输入率
(%)输入量
(ml)人均量
(ml)输入
例数输入率
(%)输入量
(ml)人均量
(ml)2011 903 83 9.19 309 3.72 24 2.66 12 400 516.67 39 4.32 16 788 430.46 2012 971 73 7.52 286 3.92 28 2.88 17 600 628.57 41 4.22 18 978 462.88 2013 990 66 6.67 284 4.30 40 4.04 25 000 625.00 46 4.65 20 939 455.20 2014 1125 71 6.31 300 4.22 43 3.82 24 400 567.44 51 4.53 25 318 496.43 合计 3989 293 7.34 1179 4.02 135 3.38 79 400 588.15 177 4.44 81 223 458.89
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表 3 2011—2014年血管外科手术患者用血量(不包含血小板用量)
年份 输血例数 异体输血 自体输血 总用血量(ml) 人均用血量(ml) 输入量(ml) 比例(%) 输入量(ml) 比例(%) 2011 105 74 200 81.55 16 788 18.45 90 988 866.55 2012 98 74 800 79.76 18 978 20.24 93 778 956.92 2013 100 81 800 79.62 20 939 20.38 102 739 1027.39 2014 100 84 400 76.20 25 318 22.86 110 753 1107.53 合计 403 315 200 79.14 82 023 20.60 398 258 988.23
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表 4 血管外科重点疾病手术方式输血情况对比
手术方式 大动脉疾病 下肢缺血性疾病 输血例数 总用血量(ml) 人均用血量(ml) 输血例数 总用血量(ml) 人均用血量(ml) 介入手术 88 72 303 821.62 27 15 200 562.96 开放手术 29 51 192 1765.24 86 56 064 651.91 杂交手术 16 27 532 1720.75 29 22 584 778.76
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