摘要
目的:分析术中大量输血对儿童患者血液检测指标的影响,探讨影响儿童生存结局的危险因素,为预防大量输血后并发症及提高儿童生存率提供依据。方法:选取2024年1月-4月术中大量输血儿童116例,按照术中输血量与自身血容量倍数分为3组:1-2倍输血量组(71例),>2且≤3倍输血量组(35例),>3倍输血量组(10例)。分析大量输血儿童输血前后血液检测指标的差异,以及大量输血前后存在差异的血液检测指标与输血倍数、输注血液成分比例的相关性,预测影响儿童生存结局的高危因素。结果:3组儿童血液检测指标,包括hcrp、PT、APTT、TT、FIB、ALT、在大量输血前后均有差异,其中输血前后有差异的指标hcrp、PT、APTT、TT、ALT与输血倍数呈正相关(r=0.053,P=0.040;r=0.118,P=0.020;r=0.186,P=0.045;r=0.046,P=0.034;r=0.075,P=0.042),FIB、Ca^(2+)与输血倍数呈负相关(r=-0.096,P=0.031;r=-0.097,P=0.029)。输血前后有差异的血液指标hcrp、PT、APTT、TT、ALT与输注血液成分比例呈正相关(r=0.060,P=0.003;r=0.049,P=0.049;r=0.149,P=0+与输注血液成分比例呈负相关(r=-0.033,P=0.047;r=-0.002,P=0.046)。多因素分析结果显示,体重(<2.1kg)、出血量(>355ml)、手术时间(>102.5min)、红细胞输注量(>2.75U)、血浆输注量(>125ml)、冷沉淀输注量(>3U)、PT(>31.8s)、APTT(>78s)、TT(>29.4s)、FIB(<0.85g/L)是影响儿童生存结局的独立危险因素(P<0.05)。结论:儿童术中大量输血与术后出现凝血障碍、肝功受损及电解质紊乱等并发症相关,以及输血量及输注血液成分比例变化均会影响症状严重程度。低体重儿、术中出血量多、手术时间长、血液成分输注量大及凝血功能紊乱可预示儿童死亡高风险率。
Objective:To analyze the influence of massive transfusion on blood test indexes in children,and to explore the risk factors of survival outcome in order to prevent complications and improve survival rate of children.Methods:One hundred and sixteen children with massive transfusion during operation from January to April 2024 were selected,according to the multiples of the amount of intraoperative blood transfusion and their own blood volume,they were divided into three groups:1-2 times transfusion volume group(71 cases),>2,≤3 times transfusion volume group(35 cases),>3 times transfusion volume group(10 cases).The difference of blood test indexes before and after massive transfusion in children was analyzed,and the correlation between those differential indicators and transfusion times,and the high risk factors affecting children′s survival outcome were predicted.Results:There were significant differences in blood indexes including hcrp,PT,APTT,TT,FIB,ALT and Ca^(2+)before and after massive transfusion.There were positive correlation between hcrp,PT,APTT,TT,ALT and transfusion times(r=0.053,P=0.040;r=0.118,P=0.020;r=0.186,P=0.045;r=0.046,P=0.034;r=0.075,P=0.042),and negative correlation between FIB,Ca^(2+)and transfusion times(r=-0.096,P=0.031;r=-0.097,P=0.029).hcrp,PT,APTT,TT,ALT were positively correlated with the blood components ratio(r=0.060,P=0.003;r=0.049,P=0.049;r=0.149,P=0.046;r=0.045,P=0.047;r=0.095,P=0.024),while FIB,Ca^(2+)were negatively correlated with the blood components ratio r=-0.033,P=0.047;r=-0.002,P=0.046).Multivariate analysis showed that weight(<2.1 kg),blood loss(>355 ml),operative time(>102.5 min),red blood cell infusion(>2.75 U),plasma infusion(>125 ml),cryoprecipitate infusion(>3 U),PT(>31.8 s),APTT(>78 s),TT(>29.4 s),FIB(<0.85 g/L)were independent risk factors for children’s survival outcome.Conclusion:Massive blood transfusion in children is associated with postoperative complications such as coagulation disorders,liver damage and electrolyte disturbance,the changes of blood transfusion volume and the blood component ratio can affect the severity of symptoms.Low weight,much intraoperative blood loss,long operative time,excessive transfusion volume and coagulation dysfunction can predict high risk of death in children.
作者
王淑霞
陈蕊
金晓红
胡美坤
吕孟兴
屈柯暄
WANG Shu-Xia;CHEN Rui;JIN Xiao-Hong;HU Mei-Kun;LYU Meng-Xing;QU Ke-Xuan(Department of Blood Transfusion,Kunming Children's Hospital,Kunming 650228,Yunnan Province,China)
出处
《中国实验血液学杂志》
北大核心
2026年第1期208-218,共11页
Journal of Experimental Hematology
基金
昆明市卫生科技人才培养项目暨“十百千”工程(2021-SW(省)-024)
昆明市卫生科技人才培养项目医学技术中心建设(2022-SW(技术)-007)
国家留学基金资助(留金项目[2023]43号)。
关键词
儿童
大量输血
血液检测指标
相关性:高危因素
children
massive blood transfusion
blood test index
relevance:high risk factors
