摘要
目的探讨未破裂颅内单发动脉瘤在动脉瘤夹闭术术前如何合理备血。方法从2016年1月—2017年12月在首都医科大学附属北京天坛医院神经外科接受未破裂颅内动脉瘤夹闭术的患者中,运用倾向性匹配评分的方式筛选出接受输血与未接受输血者各64人,收集其围手术期及手术信息,统计并对比2组患者的差异,筛选术前未破裂单发动脉瘤在夹闭术术中输血的危险因素。结果输血组与未输血组比较,患者体重(kg)为59.1±8.4 vs 65.2±11.9,动脉瘤体/颈比为1.7±0.9 vs 1.3±0.4,动脉瘤术中破裂率为57.8%(37/64)vs 4.7%(3/64),动脉瘤夹闭时间(min)63.4±10.6 vs 38.6±12.2,术中出血量(mL)811.7±426.8 vs 243.1±117.1(P<0.01),术中出血量/体重13.8±6.9 vs 3.8±1.9(P<0.01)。据此构建了术前模型和术中模型。体重(OR=4.59)和动脉瘤体/颈比(OR=4.48)是术前判断未破裂动脉瘤患者术中输血风险的预测指标。体重<55 kg的患者,中位异体红细胞输注量为260 mL;而对于动脉瘤体/颈比>1.4的患者,中位异体红细胞输注量为130 mL。结论患者的体重和动脉瘤的体/颈比为预测未破裂单发动脉瘤在夹闭术中需行输血治疗的重要指标;对于体重较轻以及动脉瘤体/颈比较大的患者,在术前应积极备血,做好输血保障。
Objective To investigate how to reasonably prepare blood for clipping surgery of unruptured intracranial single aneurysm.Methods This study retrospectively reviewed the patients who underwent clipping for unruptured intracranial single aneurysm in our institution from January 2016 to December 2017.A total of 128 patients,half of whom received blood transfusion and the other half did not,were selected by using propensity score matching and their perioperative and surgical information were collected.The risk factors for blood transfusion of unruptured intracranial single aneurysm during surgery were investigated.Results This study found that weight(59.1±8.4 vs.65.2±11.9,P<0.05),aspect ratio(1.7±0.9 vs.1.3±0.4,P<0.05),intraoperative aneurysm rupture(57.8%vs.4.7%,P<0.01),time of clipping(63.4±10.6 vs.38.6±12.2,P<0.01),intraoperative bleeding(811.7±426.8 vs.243.1±117.1,P<0.01)and bleeding/weight(13.8±6.9 vs.3.8±1.9,P<0.01)had a significantly statistical difference between transfusion and non-transfusion group.Preoperative and intraoperative models were constructed based on these risk factors.Weight(OR=4.59)and aspect ratio(OR=4.48)were preoperative predictive indicators for blood transfusion in the clipping.For patients with weight<55 kg,the median magnitude of transfusion was 260 mL;for patients with aneurysms having aspect ratio>1.4,the median magnitude of transfusion was 130 mL.Conclusion Weight and aspect ratio are important predictors for transfusion in clipping surgery for unruptured intracranial single aneurysm;for patients with light weight and aneurysms having large aspect ratio,blood preparation should be more careful in order to ensure blood usage during surgery.
作者
刘清源
王诺川
吴俊
姜朋军
曹勇
张谦
张亚南
王硕
LIU Qingyuan;WANG Nuochuan;WU Jun;JIANG Pengjun;CAO Yong;ZHANG Qian;ZHANG Yanan;WANG Shuo(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Blood Transfusion,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《中国输血杂志》
CAS
2019年第5期457-461,共5页
Chinese Journal of Blood Transfusion
基金
北京市青年科技骨干培养基金(20141210)
关键词
术前备血
未破裂颅内动脉瘤
动脉瘤夹闭术
术中出血
输血
blood preparation
unruptured intracranial aneurysm
clipping
intraoperative bleeding
blood transfusion
