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用血量大于等于20 U患者围术期血液管理

张娇 虞雪融 袁青 黄宇光

张娇, 虞雪融, 袁青, 黄宇光. 用血量大于等于20 U患者围术期血液管理[J]. 协和医学杂志, 2016, 7(5): 379-383. doi: 10.3969/j.issn.1674-9081.2016.05.011
引用本文: 张娇, 虞雪融, 袁青, 黄宇光. 用血量大于等于20 U患者围术期血液管理[J]. 协和医学杂志, 2016, 7(5): 379-383. doi: 10.3969/j.issn.1674-9081.2016.05.011
Jiao ZHANG, Xue-rong YU, Qing YUAN, Yu-guang HUANG. Perioperative Blood Management of Patients Using More Than or Equal to 20 Units of Blood[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(5): 379-383. doi: 10.3969/j.issn.1674-9081.2016.05.011
Citation: Jiao ZHANG, Xue-rong YU, Qing YUAN, Yu-guang HUANG. Perioperative Blood Management of Patients Using More Than or Equal to 20 Units of Blood[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(5): 379-383. doi: 10.3969/j.issn.1674-9081.2016.05.011

用血量大于等于20 U患者围术期血液管理

doi: 10.3969/j.issn.1674-9081.2016.05.011
详细信息
    通讯作者:

    虞雪融 电话:010-69152030, E-mail:yuxuerong@pumch.cn

  • 中图分类号: R457.1;R619+.1

Perioperative Blood Management of Patients Using More Than or Equal to 20 Units of Blood

More Information
  • 摘要:   目的  探讨手术相关用血量大于等于20 U患者围术期血液管理特点。  方法  收集并分析北京协和医院2015年度用血量大于等于20 U手术患者的围术期资料, 比较未经历非计划二次手术和经历非计划二次手术患者的相关信息。  结果  共36例患者纳入研究, 经历非计划二次手术患者(n=12)初次择期手术中失血量明显低于未经历非计划二次手术患者(n=24), 分别为1300和3000 ml(P < 0.05);但非计划二次手术相较于其初次择期手术美国麻醉医师协会(American Society of Anaesthesiology, ASA)分级明显增高, Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级分别为0、0、4、8、0例和2、9、1、0、0例; 术中出血量(分别为2250和1050 ml)和输血量(红细胞分别为8和1 U, 血浆分别为400和100 ml)亦均明显增加(P均 < 0.05)。36例患者中18例并发术前贫血。  结论  对于手术难度大、风险高的患者, 在充分评估术中出血风险的基础上, 采取个体化治疗方案, 纠正术前贫血, 术中严密止血, 加强围术期凝血功能检测, 可降低非计划二次手术的发生率, 改善患者结局。
  • 表  1  18例贫血患者术前血红蛋白水平与手术时机

    血红蛋白(g/L) 手术时机(例)
    急诊手术 择期手术
    90~120 1 7
    60~<90 3 5
    30~<60 2 0
    <30 0 0
    总计 6 12
    下载: 导出CSV

    表  2  未经历与经历非计划二次手术患者初次手术相关数据比较

    非计划二次手术 例数 ASA分级(Ⅰ/Ⅱ/Ⅲ/Ⅳ/Ⅴ) 术中出血量(ml) 术后引流量(ml)
    未经历 24 0/12/10/1/1 3000(1200, 6150) 2400(  650, 4543)
    经历 12 2/9/1/0/0 1300(  650, 2000)* 3600(2450, 9950)
    ASA:美国麻醉医师协会;与未经历非计划二次手术患者比较,* P<0.05
    下载: 导出CSV

    表  3  非计划二次手术患者手术相关数据

    手术时机 ASA分级(Ⅰ/Ⅱ/Ⅲ/Ⅳ/Ⅴ) 术中出血量(ml) 术中输血量
    红细胞(U) 血浆(ml)
    初次手术 2/9/1/0/0 1050(600, 2000) 1(0,   5) 100(0,   800)
    非计划二次手术 0/0/4/8/0 2250(1000, 4000)* 8(4,   10)* 400(400, 1400)*
    ASA:同表 2;与初次手术比较,* P<0.05
    下载: 导出CSV
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出版历程
  • 收稿日期:  2016-07-14
  • 刊出日期:  2016-09-30

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