摘要
目的探讨术前凝血因子ⅩⅢ(FⅩⅢ)活性和术后胸管引流(CTD)与心肺转流(CPB)冠状动脉旁路移植术(CABG)输血需求的关系。方法在2022年3月至2024年3月进行了一项回顾性研究,纳入了73例在本院心血管外科中心接受CPB下CABG手术的患者。根据输血指南,对有输血需求的患者在术后进行输血。术前FⅩⅢ活性采用发色底物法进行检测,并记录术后前48 h的CTD量。结果在73例患者中,共计有50例(68.49%)患者接受了术后输血。其中36例(49.32%)输注浓缩红细胞(PRBC),13例(17.81%)输注血小板,42例(57.53%)输注新鲜冰冻血浆(FFP)。与术后输血的患者比较,未输血的患者在ICU入住天数、术后插管时间、术后48 hCTD相对量(总量/体重)、术中失血量均显著降低(P<0.05);而中心静脉压、术前FⅩⅢ活性水平均显著升高(P<0.05)。多因素Logistic模型显示术前FⅩⅢ活性<96.81%(中位值)、术后前48 hCTD量≥16.70 ml/kg(中位值)是影响术后输血的独立危险因素(P<0.05)。术前FⅩⅢ活性、术后前48 hCTD量分别预测术后输血的曲线下面积(AUC)为0.731(95%CI:0.619~0.844)、0.799(95%CI:0.688~0.911),而二者联合预测术后输血时AUC提高到0.879(95CI:0.785~0.973)。Spearman相关性显示术后前48 h CTD量与PRBC输注总量(Rho=0.529)、FFP输注总量(Rho=0.3779)均呈正相关(P<0.05)。结论本研究的结果证明,虽然术前FⅩⅢ活性与术后CTD量无关,但术前FⅩⅢ活性低、术后CTD相对量多的患者,更可能接受术后输血。
Objective To investigate the relationship between preoperative coagulation factorⅩⅢ(FⅩⅢ)activity,postoperative chest tube drainage(CTD)and transfusion requirements for coronary artery bypass grafting(CABG)with cardiopulmonary bypass(CPB).Methods A retrospective study was conducted from March 2022 to March 2024,which included 73 patients who underwent CPB CABG at our cardiovascular surgery center.Patients with transfusion requirements were transfused postoperatively according to transfusion guidelines.Preoperative FⅩⅢactivity was assayed by using a color-emitting substrate method,and the CTD volume in the first 48 h postoperatively was recorded.Results Of the 73 patients,a total of 50(68.49%)received postoperative blood transfusions.Of these,36(49.32%)were transfused with packed red blood cells(PRBCs);13(17.81%)were transfused with platelets(PLTs);and 42(57.53%)were transfused with fresh frozen plasma(FFP).Compared with patients who were transfused postoperatively,those who were not transfused had significantly lower ICU length of stay,postoperative intubation time,48 h postoperative CTD relative volume(total volume/body weight),and intraoperative blood loss(P<0.05);whereas central venous pressure(CVP)and preoperative FⅩⅢactivity level were significantly higher(P<0.05).Multifactorial logistic modeling showed that preoperative FⅩⅢactivity<96.81%(median value)and 48 h postoperative CTD relative volume≥16.70 ml/kg(median value)in the first 48 h postoperatively were independent risk factors affecting postoperative blood transfusion(P<0.05).The area under the curve(AUC)of preoperative FⅩⅢactivity and the 48 h postoperative CTD relative volume predicting postoperative blood transfusion was 0.731(95%CI:0.619~0.844)and 0.799(95%CI:0.688~0.911),respectively,and the AUC was increased to 0.879(95%CI:0.785~0.973)for the combination of the two predicting postoperative blood transfusion.Spearman’s correlation showed that the 48 h postoperative CTD relative volume was positively correlated with the total amount of PRBC transfusion(Rho=0.529)and FFP transfusion(Rho=0.3779),P<0.05.Conclusion The results of this study demonstrate that although preoperative FⅩⅢactivity is not related to the amount of postoperative CTD,patients with low preoperative FⅩⅢactivity and a relatively high amount of postoperative CTD are more likely to receive postoperative transfusions.
作者
葛菲
宋爽
徐徐
寇平
Ge Fei;Song Shuang;Xu Xu;Kou Ping(Department of Geriatrics,the First Hospital of China Medical University,Liaoning Shenyang 110000,China)
出处
《中国体外循环杂志》
2025年第4期311-317,共7页
Chinese Journal of Extracorporeal Circulation
基金
辽宁省高等学校科学研究项目(LJKQZ20222350)。
关键词
凝血因子ⅩⅢ
胸管引流
心肺转流
冠状动脉旁路移植术
输血
Coagulation factorⅩⅢ
Chest tube drainage
Cardiopulmonary bypass
Coronary artery bypass grafting
Blood transfusion
