老年患者术中不同输血方式对预后影响的临床研究

doi:10.3760/cma.j.issn.1007-1245.2022.10.015

国际医药卫生导报 ›› 2022, Vol. 28 ›› Issue (10): 1394-1398.DOI: 10.3760/cma.j.issn.1007-1245.2022.10.015

老年患者术中不同输血方式对预后影响的临床研究

付昕许瑶马春玲李婉葵邓开清

广东医科大学附属东莞第一医院输血科，东莞　523000

收稿日期:2021-12-01 出版日期:2022-05-15 发布日期:2022-05-16
通讯作者: 付昕，Email：xinfu0828@163.com
基金资助:
2019年度东莞市社会科技发展（一般）项目（201950715032867）

Clinical research on the prognosis of restrictive versus liberal strategy for blood transfusion in elderly patients during operation

Fu Xin, Xu Yao, Ma Chunling, Li Wankui, Deng Kaiqing

Department of Blood Transfusion, The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan 523000, China

Received:2021-12-01 Online:2022-05-15 Published:2022-05-16
Contact: Fu Xin, Email: xinfu0828@163.com
Supported by:
Dongguan Social Science and Technology Development (General) Project in 2019 (201950715032867)

摘要/Abstract

摘要： 目的　研究限制性输血与开放性输血2种不同输血方式在不同择期手术老年患者中的预后。方法　选取2019年1月至2021年6月广东医科大学附属东莞第一医院各种择期手术老年患者80例，使用电脑数字随机分为两组，各40例。对照组男26例、女14例，年龄（64.82±2.71）岁，为开放性输血，红细胞输注时机为血红蛋白（Hb）<100 g/L；观察组男22例、女18例，年龄（65.67±3.39）岁，为限制性输血，输血时机为Hb<70 g/L。记录并比较手术前（T0）、手术结束时刻（T1）、术后1 d（T2）及术后7 d（T3）两组患者安全性指标及有效性指标。计量资料采用t检验，计数资料采用χ²检验。结果　T0时，两组患者平均动脉压（MAP）、心率（HR）、Hb、凝血酶原时间国际标准化比值（PT-INR）及肌酐（Crea）指标比较，差异均无统计学意义（均P>0.05）；T1、T2、T3时，观察组MAP、HR、PT-INR及Crea与对照组相比，差异均无统计学意义（均P>0.05），而观察组Hb水平为（81.50±12.17）g/L、（101.60±8.33）g/L、（117.45±18.23）g/L，均明显低于对照组（109.00±11.23）g/L、（125.33±9.34）g/L、（136.50±25.55）g/L，差异均有统计学意义（均P<0.05）。T0时，两组患者脑动脉血氧含量（CaO₂）、脑氧摄取率（CEO₂）、乳酸（Lac）及简易智力状态检查量表（MMSE）评分比较，差异均无统计学意义（均P>0.05）；T1、T2、T3时，观察组CaO₂、CEO₂、Lac指标与对照组比较，差异均无统计学意义（均P>0.05）；T2、T3时，观察组MMSE评分为（24.04±1.91）分、（27.32±2.14）分，均明显高于对照组（21.81±2.48）分、（23.51±2.31）分，差异均有统计学意义（均P<0.05）。观察组输血量、并发症发生率分别为（2.08±0.26）U、5.00%（2/40），均低于对照组（3.17±0.83）U、15.00%（6/40），差异均有统计学意义（均P<0.05）。结论　对于老年择期手术患者进行限制性输血，能有效平衡脑氧代谢水平，维持患者循环稳定，并促进认知功能的恢复。

关键词: 限制性输血, 认知功能, 择期手术

Abstract:

Objective　To explore the effects of restrictive and liberal blood transfusion on the prognosis in elderly patients undergoing different elective surgeries. Methods　A total of 80 elderly patients undergoing elective surgery in The First Dongguan Affiliated Hospital of Guangdong Medical University from January 2019 to June 2021 were randomly evenly divided into two groups using computer numbers. There were 26 males and 14 females in the control group, aged (64.82±2.71) years; there were 22 males and 18 females in the observation group, aged (65.67±3.39) years. The patients in the control group were given liberal blood transfusion when hemoglobin (Hb) <100 g/L, while the patients in the observation group were given restrictive blood transfusion when Hb <70 g/L. The safety and efficacy indexes of the two groups were recorded and compared before surgery (T0), at the end of surgery (T1), 1 day after surgery (T2), and 7 days after surgery (T3). t test was used for the measurement data and χ² test was used for the count data. Results　At T0, there were no statistically significant differences in the mean arterial pressure (MAP), heart rate (HR), Hb, international standardized ratio of prothrombin time (PT-INR), and creatinine (Crea) between the two groups (all P>0.05). At T1, T2, and T3, there were no statistically significant differences in the MAP, HR, PT-INR, and Crea between the observation group and the control group (all P>0.05); the Hb levels of the observation group were (81.50±12.17) g/L, (101.60±8.33) g/L, and (117.45±18.23) g/L, which were significantly lower than those of the control group [(109.00±11.23) g/L, (125.33±9.34) g/L, and (136.50±25.55) g/L], with statistically significant differences (all P<0.05). At T0, there were no statistically significant differences in the cerebral arterial blood oxygen content (CaO₂), cerebral oxygen uptake rate (CEO₂), lactic acid (Lac), and Mini-Mental State Examination (MMSE) score between the two groups (all P>0.05). At T1, T2 and T3, there were no statistically significant differences in the CaO₂, CEO₂, and Lac between the observation group and the control group (all P>0.05). At T2 and T3, the MMSE scores in the observation group were (24.04±1.91) points and (27.32±2.14) points, which were significantly higher than those in the control group [(21.81±2.48) points and (23.51±2.31) points], with statistically significant differences (both P<0.05). The blood transfusion volume and incidence of complications in the observation group were (2.08±0.26) U and 5.00% (2/40), respectively, which were lower than those in the control group [(3.17±0.83) U and 15.00% (6/40)], with statistically significant differences (both P<0.05). Conclusion　Restrictive blood transfusion for elderly patients undergoing elective surgery can effectively balance the level of cerebral oxygen metabolism, maintain the stability of circulation, and promote the recovery of cognitive function.

Key words: Restrictive strategy for red blood cell transfusion, Cognitive function, Elective surgery

付昕, 许瑶, 马春玲, 李婉葵, 邓开清. 老年患者术中不同输血方式对预后影响的临床研究[J]. 国际医药卫生导报, 2022, 28(10): 1394-1398.

Fu Xin, Xu Yao, Ma Chunling, Li Wankui, Deng Kaiqing. Clinical research on the prognosis of restrictive versus liberal strategy for blood transfusion in elderly patients during operation[J]. International Medicine and Health Guidance News, 2022, 28(10): 1394-1398.

参考文献

[1] 陈佳,余泽波. 临床输血策略进展[J]. 临床输血与检验,2018,20(1):100-106. DOI:10.3969/j.issn.1671-2587. 2018.01.035.

[2] 范玥. 髋关节手术中输血策略研究进展[J]. 检验医学与临床,2021,18(7):1008-1010. DOI:10.3969/j.issn.1672- 9455.2021.07.044.

[3] 徐宵寒,虞雪融,黄宇光. 围手术期限制性红细胞输注的研究进展与指南对比[J]. 中国医学科学院学报,2019,41(4):541-547. DOI:10.3881/j.issn.1000-503X.10675.

[4] 韩文导. 开放性和限制性输血策略对髋关节置换术老年患者预后的影响[J]. 临床输血与检验,2016,18(6):531-533. DOI:10.3969/j.issn.1671-2587.2016.06.006.

[5] 中华人民共和国卫生部.临床输血技术规范[J].中国医院,2000,4(6):16-17.

[6] 陈雪飞,王秀芳,王银华,等. 限制性输血对神经外科老年手术患者脑能量代谢、细胞因子及认知功能的影响[J]. 川北医学院学报,2021,36(5):648-651. DOI:10.3969/j.issn.1005-3697.2021.05.026.

[7] 吴沁娟,周荣华,刘斌.心脏手术患者输血策略的系统评价[J].生物医学工程学杂志,2014,31(2):319-326. DOI:10.7507/1001-5515.20140060.

[8] Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group[J].N Engl J Med,1999,340(6):409-417. DOI:10.1056/NEJM199902113400601.

[9] 郑丽丽,朱昭琼,张帆. 骨科手术术中限制性与开放性输血的对比观察[J]. 遵义医学院学报,2014,37(6):644-646. DOI:10.14169/j.cnki.zunyixuebao.2014.0050.

[10] 郭娜,秦再生,叶靖,等. 限制性输液在妇科腹腔镜手术中的初步应用[J]. 数理医药学杂志,2013,26(1):32-35. DOI:10.3969/j.issn.1004-4337.2013.01.010.

[11] 廖刃,刘进. 围手术期血液管理:由限制性输血走向个体化输血[J]. 中华医学杂志,2014,94(7):481-482. DOI:10.3760/cma.j.issn.0376-2491.2014.07.001.

[12] 李志强. 危重病患者个体化输血策略与管理[J]. 临床输血与检验,2016,18(2):97-100. DOI:10.3969/j.issn.1671- 2587.2016.02.001.

老年患者术中不同输血方式对预后影响的临床研究

Clinical research on the prognosis of restrictive versus liberal strategy for blood transfusion in elderly patients during operation

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 4

编辑推荐

Metrics

[1]	龚晨, 申潇竹, 包勤文, 赵晓斐. 维生素D水平与老年脑小血管病患者认知功能障碍的相关性研究[J]. 国际医药卫生导报, 2022, 28(8): 1081-1085.
[2]	蒋佳, 周静怡, 纪小静, 胡小静. 基于扎根理论的干预措施应用于老年糖尿病患者中的效果观察[J]. 国际医药卫生导报, 2022, 28(5): 641-645.
[3]	李艺. 术前高压氧处理对冠状动脉搭桥术患者术后的影响分析[J]. 国际医药卫生导报, 2022, 28(3): 425-428.
[4]	邵可可, 汝文文. 金刚烷胺联合达灵复治疗帕金森病患者的随机对照研究[J]. 国际医药卫生导报, 2021, 27(6): 881-884.