中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2012年
5期
316-319
,共4页
体外循环%手术后出血%危险因素
體外循環%手術後齣血%危險因素
체외순배%수술후출혈%위험인소
Extracorporeal circulation%Postoperative hemorrhage%Risk factors
目的 筛选体外循环(CPB)心脏手术患者围手术期(简称围术期)发生大量出血的危险因素.方法 回顾性分析2001年1月至2010年5月浙江大学医学院附属邵逸夫医院择期行心脏手术的成人患者1079例,根据是否有围术期大量出血,分为2组:大量出血组和非大量出血组,两组分别为120例和959例.可疑的危险因素进行组间比较后,将差异有统计学意义的因素进行Logistic回归分析,筛选发生围术期大量出血的危险因素.结果 围术期发生大量出血120例,发生率为11.1％.Logistic回归分析显示,大量出血的危险因素为:年龄(OR=4.533,95％ CI 2.624～7.831)、有心脏手术史( OR=2.781,95％ CI 1.410～5.486)、术前红细胞压积(Hct)水平(OR=0.896,95％ CI0.861～0.932)、CPB时间(OR=2.782,95％ CI1.791～4.322)、手术类型(OR=2.292,95％ CI1.376～3.817).结论 老年、心脏手术史、术前低Hct水平、CPB时间≥120 min、复杂手术为CPB心脏手术围术期发生大量出血的独立危险因素.
目的 篩選體外循環(CPB)心髒手術患者圍手術期(簡稱圍術期)髮生大量齣血的危險因素.方法 迴顧性分析2001年1月至2010年5月浙江大學醫學院附屬邵逸伕醫院擇期行心髒手術的成人患者1079例,根據是否有圍術期大量齣血,分為2組:大量齣血組和非大量齣血組,兩組分彆為120例和959例.可疑的危險因素進行組間比較後,將差異有統計學意義的因素進行Logistic迴歸分析,篩選髮生圍術期大量齣血的危險因素.結果 圍術期髮生大量齣血120例,髮生率為11.1％.Logistic迴歸分析顯示,大量齣血的危險因素為:年齡(OR=4.533,95％ CI 2.624～7.831)、有心髒手術史( OR=2.781,95％ CI 1.410～5.486)、術前紅細胞壓積(Hct)水平(OR=0.896,95％ CI0.861～0.932)、CPB時間(OR=2.782,95％ CI1.791～4.322)、手術類型(OR=2.292,95％ CI1.376～3.817).結論 老年、心髒手術史、術前低Hct水平、CPB時間≥120 min、複雜手術為CPB心髒手術圍術期髮生大量齣血的獨立危險因素.
목적 사선체외순배(CPB)심장수술환자위수술기(간칭위술기)발생대량출혈적위험인소.방법 회고성분석2001년1월지2010년5월절강대학의학원부속소일부의원택기행심장수술적성인환자1079례,근거시부유위술기대량출혈,분위2조:대량출혈조화비대량출혈조,량조분별위120례화959례.가의적위험인소진행조간비교후,장차이유통계학의의적인소진행Logistic회귀분석,사선발생위술기대량출혈적위험인소.결과 위술기발생대량출혈120례,발생솔위11.1％.Logistic회귀분석현시,대량출혈적위험인소위:년령(OR=4.533,95％ CI 2.624～7.831)、유심장수술사( OR=2.781,95％ CI 1.410～5.486)、술전홍세포압적(Hct)수평(OR=0.896,95％ CI0.861～0.932)、CPB시간(OR=2.782,95％ CI1.791～4.322)、수술류형(OR=2.292,95％ CI1.376～3.817).결론 노년、심장수술사、술전저Hct수평、CPB시간≥120 min、복잡수술위CPB심장수술위술기발생대량출혈적독립위험인소.
Objective To evaluate the pre- and intraoperative risk factors associated with excessive bleeding during the perioperative period in adult patients undergoing open heart surgery with cardiopulmonary bypass (CPB).Methods A total of 1079 consecutive patients undergoing open heart surgery with CPB from January 2001 to May 2010 were included ( except for emergency operation).The possible risk factors associated with excessive bleeding were retrospectively analyzed.Patients who received ≥7 units of RBC or had a re-operation during which no active bleeding point was found within one day of operation were classified as excessive bleeding.According to the occurrence of excessive bleeding,they were divided into 2 groups:excessive and non-excessive bleeding groups.The possible risk factors associated with excessive bleeding were retrospectively analyzed.Univariate analysis and multivariate Logistic regression analysis were used to examine the relationship between these factors and excessive bleeding. Results Among them,120(11.1％ ) developed excessive bleeding.Multivariate Logistic analysis indicated that the risk factors for excessive bleeding were age ( OR =4.533,95％ CI 2.624 - 7.831 ),previous sternotomy ( OR =2.781,95％ CI 1.410 - 5.486 ),preoperative hematocrit concentration ( OR =0.896,95％ CI 0.861 - 0.932 ),CPB duration ( OR =2.782,95 ％ CI 1.791 - 4.322) and type of procedure ( OR =2.292,95％ CI 1.376 -3.817).Conclusion Age ≥ 65 years,previous sternotomy,preoperative low hematocrit concentration,CPB duration ≥ 120min and complex operation were the significant predictors for excessive bleeding in patient undergoing open heart surgery with CPB.
