国际麻醉学与复苏杂志   2019, Issue (9): 0-0
    
对于严重产后出血患者红细胞输注终止时机的回顾性研究
蔡恒宇1()
1.沈阳市妇婴医院
Retrospective study on the timing of termination of erythrocyte infusion in patients with severe postpartum hemorrhage
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摘要:

目的 对严重产后出血患者进行回顾性研究,评估患者红细胞输注终止时机的选择,寻找合理的红细胞输注终止指标,以指导临床工作。 方法 以停止输注红细胞时Hb和Hct值为检验变量,以输注红细胞后24 h Hb>70 g/L为状态变量,绘制受试者工作特征曲线(receiver operating characteristic curve, ROC曲线),计算ROC曲线下面积(area under receiver operating characteristic curve, AUC)、截断值(cut-off值)。以ROC曲线中AUC面积大者为基础,进行分组研究。本研究共检索病例30 682例,发生严重产后出血87例,其发生率为0.28%。以停止输注红细胞时Hb cut-off值86.5 g/L为分割点,将严重产后出血患者分为两组:停止输注红细胞时Hb≤86.5 g/L组(A组,34例)、停止输注红细胞时Hb>86.5 g/L组(B组,53例)。比较两组患者出血量、输血量、停止输注红细胞后Hb含量及停止输注红细胞24 h后心率、MAP、SpO2,比较两组患者新发器官损伤情况、患者住院天数、住院总花费。 结果 计算停止输注红细胞时Hb的AUC面积为0.825(95%CI 0.725~0.925),cut-off值为86.5 g/L(敏感度72.5%,特异度87.5%)。停止输注红细胞时Hct的AUC面积为0.780(95%CI 0.665~0.895),cut-off值为27.65%(敏感度65.2%,特异度71.2%)。两组患者出血量比较,差异无统计学意义(P>0.05)。A组停止输注红细胞后Hb为(79±6) g/L,B组(100±10) g/L,两组比较差异有统计学意义(P<0.05)。A组患者输血量(5±3) U,B组(6±5) U,两组比较差异有统计学意义(P<0.05)。停止输注红细胞24 h后,A组患者心率[(94±14) 次/min]大于B组[(83±13) 次/min](P<0.05);两组患者MAP、SpO2比较,差异无统计学意义(P>0.05)。48 h内B组氧合指数<300的发生率高于A组(P<0.05)。两组患者住院天数和住院总花费比较,差异无统计学意义(P>0.05)。 结论 在评估严重产后出血患者停止输注红细胞指标中Hb优于Hct,停止红细胞输注时Hb为>86.5 g/L可能对机体更有益。同时发现随着红细胞输注的增加可能会增加器官损伤的发生。

关键词: 产后出血; 红细胞输注; 终止时机; 受试者工作特征曲线
Abstract:

Objective To evaluate the appropriate time and reasonable indicator of ending the erythrocyte transfusion in patients with severe postpartum hemorrhage. Methods A retrospective study was performed, where the hemoglobin (Hb) and hematocrit (Hct) values were taken as test variables and the infusion of erythrocytes was stopped, and the Hb>70 g/L of 24 h after the infusion of erythrocytes was taken as the state variable, and the receiver operating characteristic (ROC) curve was drawn to calculate area under receiver operating characteristic curve(AUC) and cut-off value. Based on the AUC area in the ROC curve, the study was conducted. Patients with severe postpartum hemorrhage whose test variables were less than or equal to cut-off value were divided into group A(n=34), and the rest were divided into group B(n=53). Bleeding volume, blood transfusion volume, hemoglobin content after red blood cell infusion were stopped, and heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) were compared 24 h after red blood cell infusion was stopped. The damage of new organs, length of stay and total cost of hospitalization were compared in the two groups. Results The AUC area of Hb was calculated as 0.825 [95%confidence interval (CI) 0.725-0.925] when the infusion was stopped, and the cut-off value of Hb when the infusion was stopped was 86.5 g/L (sensitivity 72.5%, specificity 87.5%). The AUC area of Hct was 0.780 (95%CI 0.665-0.895) when the infusion was stopped, and the cut-off value of Hct when the infusion was stopped was 27.65% (sensitivity 65.2% and specificity 71.2%). There was no significant difference in bleeding volume between the two groups (P>0.05). The mean Hb values of the patients in the two groups were (79±6) g/L in group A and (100±10) g/L in group B, respectively, after the transfusion of erythrocytes was stopped. The difference between the two groups was statistically significant (P<0.05). The blood transfusion volume of patients in the two groups was (5±3) U in group A and (6±5) U in group B, respectively, and the difference between the two groups was statistically significant (P<0.05). HR of patients in the two groups after 24 h suspension of erythrocyte infusion was (94±14) bpm in group A and (83±13) bpm in group B, respectively, with statistically significant difference between the two groups (P<0.05). There was no statistical significance in MAP and SpO2 comparison between the two groups after 24 h (P>0.05). The incidence of oxygenation index<300 in group B was higher than group A, with statistically significant differences between the two groups(P<0.05). There was no significant difference in length of stay and total cost between the two groups (P>0.05). Conclusions Hb is better than Hct in evaluating the indicators of stopping transfusion of red blood cells in patients with severe postpartum hemorrhage. When the body Hb reached 86.5 g/L, it was possible the appropriate time for ending erythrocyte transfusion, with beneficial effects on the body. It was also found that the occurrence of organ injury rises with the increase of erythrocyte transfusion.

Key words: Postpartum hemorrhage; Erythrocyte infusion; Terminating time; Receiver operating characteristic curve