摘要
目的探讨成人静脉-动脉体外膜氧合(V-A ECMO)期间血制品使用情况。方法回顾性总结阜外医院自2017年1月至2019年6月成人V-A ECMO患者资料,经排除后纳入49例,根据是否接受心脏手术,分为手术组(n=32)和非手术组(n=17);根据各自出院结局,又分为手术-院内死亡组(n=15)和手术-院内存活组(n=17)、非手术-院内死亡组(n=6)和非手术-院内存活组(n=11),分别记录ECMO运行期间红细胞悬液、新鲜冰冻血浆和血小板的输注量,并分析其对院内死亡率的影响。结果成人V-A ECMO期间红细胞悬液输注率83.7%,新鲜冰冻血浆输注率77.6%,血小板输注率63.3%,仅6.1%的患者未输注任何血制品。手术组三种血制品用量显著高于非手术组(P<0.05);非手术-院内死亡组新鲜冰冻血浆和血小板输注量高于非手术-院内存活组(P<0.05)。logistic回归分析显示成人V-A ECMO期间红细胞悬液和血小板输注量是影响手术组患者院内死亡率的独立危险因素,OR值均为8.78。结论成人V-A ECMO期间血制品使用量显著增加,其中红细胞悬液和血小板输注量是影响手术患者院内死亡率的独立危险因素。
Objective To investigate the use of blood products during veno-arterial extracorporeal membrane oxygenation(VA ECMO)in adults.Methods The data of adult patients with V-A ECMO in Fuwai Hospital from January 2017 to June 2019 were reviewed retrospectively.49 patients were included after exclusion.According to whether received cardiac surgery or not,they were di⁃vided into surgical group(n=32)and non-surgical group(n=17).According to the discharge outcome,they were divided into opera⁃tion-hospital death group(n=15),operation-hospital survival group(n=17),non-operation-hospital death group(n=6)and non-operation-hospital survival group(n=11).The transfusions of red blood cells,plasma and platelets during ECMO were recorded re⁃spectively,and the effect of blood product transfusion on hospital mortality was analyzed.Results Red blood cell transfusion rate was 83.7%,the plasma transfusion rate was 77.6%,and the platelet transfusion rate was 63.3%during V-A ECMO in adult patients.Only 6.1%of the patients did not receive any blood products.The dosage of red blood cell,plasma and platelet in the surgical group was sig⁃nificantly higher than that in the non-surgical group(P<0.05).The amount of fresh frozen plasma and platelet transfusion in the non-operation-hospital death group was higher than that in the non-operation-hospital survival group(P<0.05).Logistic regression a⁃nalysis showed that platelet transfusion and red blood cell transfusion were independent risk factors for in-hospital death rate in the op⁃eration group during V-A ECMO(OR 8.78).Conclusion The use of blood products increased in adults during V-A ECMO.Red blood cell and platelet transfusion were independent risk factors for in-hospital mortality during V-A ECMO in surgical patients.
作者
滕媛
王建
闫姝洁
刘刚
吉冰洋
Teng Yuan;Wang Jian;Yan Shujie;Liu Gang;Ji Bingyang(Department of Extracorporeal Circulation,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037 China)
出处
《中国体外循环杂志》
2020年第5期283-288,共6页
Chinese Journal of Extracorporeal Circulation
关键词
体外膜氧合
输血
血制品
出血
心脏手术
Extracorporeal membrane oxygenation
Blood transfusion
Blood products
Bleeding
Cardiac surgery
