青少年脊柱侧弯后路矫形手术围术期异体输血的危险因素

doi:10.16352/j.issn.1001-6325.2022.09.1419

基础医学与临床 ›› 2022, Vol. 42 ›› Issue (9): 1419-1423.doi: 10.16352/j.issn.1001-6325.2022.09.1419

青少年脊柱侧弯后路矫形手术围术期异体输血的危险因素

马满姣¹, 马璐璐^1*, 张秀华¹, 仉建国², 沈建雄², 张爱华³, 陈林⁴, 刘长城⁵

1. 中国医学院科学院北京协和医学院北京协和医院麻醉科,北京 100730;
2. 中国医学院科学院北京协和医学院北京协和医院骨科,北京 100730;
3. 北京大学第三医院麻醉科,北京100191;
4. 北京市平谷区妇幼保健院麻醉科,北京 101200;
5. 首都医科大学大兴教学医院麻醉科,北京 102600

收稿日期:2021-06-01 修回日期:2021-10-09 出版日期:2022-09-05 发布日期:2022-09-02
通讯作者: malulu@pumch.cn

Risk factors for perioperative allogeneic blood transfusion in adolescent scoliosis posterior correction surgery

MA Man-jiao¹, MA Lu-lu^1*, ZHANG Xiu-hua¹, ZHANG Jian-guo², SHEN Jian-xiong², ZHANG Ai-hua³, CHEN Lin⁴, LIU Chang-cheng⁵

1. Department of Anesthesiology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730;
2. Department of Orthopedic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730;
3. Department of Anesthesiology, Peking University Third Hospital, Beijing 100191;
4. Department of Anesthesiology, Maternal and Child Health Care Hospital, Pinggu District, Beijing 101200;
5. Department of Anesthesiology, Daxing Teaching Hospital, Capital Medical University, Beijing 102600, China

Received:2021-06-01 Revised:2021-10-09 Online:2022-09-05 Published:2022-09-02

摘要/Abstract

摘要： 目的了解青少年脊柱侧弯(AS)后路矫形术围术期异体红细胞(RBC)输注率及其危险因素。方法本研究为回顾性队列研究。收集2015年1月至2017年5月在北京协和医院行脊柱侧弯后路矫形手术的青少年的围术期临床资料。根据围术期是否接受异体输血,将患者分为异体输血组和非输血组,比较两组的临床特征。采用二分类Logistic回归分析其异体输血的危险因素。结果 469例患者纳入研究,其围术期异体输血率为30.5%,危险因素为校正体质量指数(BMI)(OR=0.887, 95% CI: 0.815~0.966, P＜0.01)、其他类型(相比于特发性)脊柱侧弯(OR=3.847, 95% CI: 1.660~8.917, P＜0.01)、术前贫血(OR=6.322, 95% CI: 2.053~19.473, P＜0.01)、手术节段＞12.5个(OR=3.554, 95% CI: 2.174~5.885, P＜0.001)、术前Cobb角＞64.5°(OR=2.381, 95% CI: 1.356~4.178, P＜0.01)和截骨手术(OR=7.551, 95% CI: 3.258~17.503, P＜0.001)。与非输血组相比,输血组患者术后返重症加强护理病房(ICU)率更高(P＜0.001)、住院时间更长(P＜0.001)和住院花费更多(P＜0.001)。结论 AS后路矫形手术围术期异体RBC输血的危险因素包括校正BMI、其他类型脊柱侧弯、术前贫血、手术节段＞12.5个、术前Cobb角＞64.5°和截骨手术。

关键词: 青少年, 脊柱侧弯, 后路矫形手术, 异体红细胞(RBC)输血

Abstract: Objective To investigate the perioperative rate of allogeneic red blood cell (RBC) transfusion in adolescent scoliosis(AS) that underwent posterior correction surgeries, and to identify its risk factors. Methods This study was a retrospective cohort study. Anesthetic data of adolescent scoliosis patients who underwent posterior correction surgeries from January 2015 to May 2017 in Peking Union Medical College Hospital were collected and analyzed. The clinical variables were subsequently compared between patients who received allogeneic RBC transfusion(transfusion group) and those who did not (non-transfusion group). Binary logistic regression analysis was performed to identify risk factors in perioperative allogeneic RBC transfusion in these patients. Results The study enrolled 469 patients. The perioperative rate of allogeneic RBC transfusion was 30.5% and the independent risk factors leading to it included corrected body mass index (BMI) (OR=0.887, 95% CI: 0.815-0.966, P＜0.01),other type of scoliosis (OR=3.847, 95% CI: 1.660-8.917, P＜0.01) (compared with idiopathic scoliosis), preoperative anemia (OR=6.322, 95% CI: 2.053-19.473, P＜0.01), the number of fused levels more than 12.5 (OR=3.554, 95% CI: 2.174-5.885, P＜0.001), preoperative Cobb angle larger than 64.5° (OR=2.381, 95% CI: 1.356-4.178, P＜0.01) and osteotomy (OR=7.551, 95% CI: 3.258-17.503,P＜0.001). The postoperative transfer rate to intensive care unit(ICU)(P＜0.001) in transfusion group was higher, with longer hospital stay length(P＜0.001) and higher cost(P＜0.001), than that in the non-transfusion group. Conclusions The risk factors for perioperative allogeneic RBC transfusion in AS include corrected BMI, other type of scoliosis, preoperative anemia, the number of fused levels more than 12.5, preoperative Cobb angle larger than 64.5° and osteotomy.

Key words: adolescent, scoliosis, posterior correction surgery, allogeneic red blood cell(RBC) transfusion

中图分类号:

R687.3

马满姣, 马璐璐, 张秀华, 仉建国, 沈建雄, 张爱华, 陈林, 刘长城. 青少年脊柱侧弯后路矫形手术围术期异体输血的危险因素[J]. 基础医学与临床, 2022, 42(9): 1419-1423.

MA Man-jiao, MA Lu-lu, ZHANG Xiu-hua, ZHANG Jian-guo, SHEN Jian-xiong, ZHANG Ai-hua, CHEN Lin, LIU Chang-cheng. Risk factors for perioperative allogeneic blood transfusion in adolescent scoliosis posterior correction surgery[J]. Basic & Clinical Medicine, 2022, 42(9): 1419-1423.

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青少年脊柱侧弯后路矫形手术围术期异体输血的危险因素

Risk factors for perioperative allogeneic blood transfusion in adolescent scoliosis posterior correction surgery

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