急诊手术围手术期输血与术后感染及并发症的关系

doi:10.3969/j.issn.1009-976X.2020.03.025

摘要/Abstract

摘要： 目的分析急诊手术患者围手术期输血与术后感染的关系。方法收集2011年至2015年部分急诊手术住院患者病历资料,包括患者基线资料、围手术期临床和实验室数据以及住院期间并发症资料。输血的定义范围为从患者入院到出院的任何输血事件。主要记录术后感染性事件,包括切口和手术部位感染、伤口裂开、尿路感染、肺炎、败血症和感染性休克;次要记录包括住院时间、非计划气管插管、呼吸机使用超过48小时、急性肾衰竭,任何血栓栓塞事件和意外再次手术探查等。结果在收集到的3153例急诊手术患者中,共242例（7.7%）接受输血治疗,接受输血患者年龄大于无输血患者,输血组BMI低于未输血组;输血患者ASA分类3级和4级低于未输血组;输血患者的平均总手术时间、总住院时间比无输血组长;输血患者发生血栓栓塞并发症的风险,如肺栓塞、深静脉血栓、呼吸功能障碍的风险增高;输血患者更有可能进行非计划气管插管。本组病例共594例患者（18.83%, 594/3135）发生术后感染事件,其中输血患者的感染率占所有输血者的39.7%（96/242）;糖尿病、COPD、慢性心脏病和高血压等慢性疾病史有显著性差异;体重减轻超过10%、较高ASA评分及污染严重伤口更容易感染;皮质类固醇使用、出血性疾病的也更容易感染。此外,低蛋白血症、低血细胞比容和也存在显著差异;开放手术感染率高于腹腔镜手术。结论急诊手术患者接受输血与术后感染性并发症的风险增加有关。

关键词: 输血, 感染, 并发症, 急症手术

Abstract: Objective To analyze the relationship between perioperative blood transfusion and postoperative infection in emergency patients. Methods The data of emergency surgery from 2011 to 2015 were collected, including baseline data, perioperative clinical and laboratory record and complications. Blood transfusion was defined as any transfusion event from admission to discharge. The main records were postoperative infectious events, including incision and surgical site infection, wound rupture, urinary tract infection, pneumonia, septicemia and septic shock; the secondary records included hospital stay, unplanned tracheal intubation, ventilator use for more than 48 hours, acute renal failure, any thromboembolism event and accidental reoperation exploration. Results Of the 3153 emergency surgery, 242 （7.7%） received perioperative blood transfusion. The patients who received blood transfusion were older than those who did not receive blood transfusion. The BMI of the blood transfusion group was lower than that of the non-blood transfusion group. ASA classification of the blood transfusion patients was lower than that of the non-blood transfusion group at levels 3 and 4. The operation time and hospitalization time of the blood transfusion patients were longer than that of the non-blood transfusion group. The risk of thromboembolism complications of the blood transfusion patients, such as pulmonary embolism, deep vein thrombosis and respiratory dysfunction, was increased, and the patients with blood transfusion were more likely to have unplanned tracheal intubation. There were 594 postoperative infection events （18.83%） occurred, in which the infection rate of blood transfusion patients accounted for 39.7% （96/242） in blood transfusion patients. There were significant differences in the history of chronic diseases such as diabetes, COPD, chronic heart disease and hypertension. Patients with weight loss more than 10%, higher ASA score,contaminated surgical wounds, corticosteroids user, and hemorrhagic disease were also more likely to infect. In addition, there were significant differences in hypoproteinemia and hematocrit, and the infection rate of open surgery was higher than that of laparoscopic surgery. Conclusion Transfusion in emergency patients is associated with an increased risk of postoperative infectious complications.

Key words: transfusion, infection, complication, emergency surgery

中图分类号:

谢建珠, 肖帆, 常瑞明. 急诊手术围手术期输血与术后感染及并发症的关系[J]. 岭南现代临床外科, 2020, 20(03): 376-380.

XIE Jian-zhu, XIAO Fan, CHANG Rui-ming. Perioperative blood transfusion is associated with post-operative infectious complications in patients underwent emergency surgery[J]. Lingnan Modern Clinics in Surgery, 2020, 20(03): 376-380.

参考文献

[1] Shaw RE, Johnson CK, Ferrari G et al. Blood transfusion in cardiac surgery does increase the risk of 5-year mortality: results from a contemporary series of 1714 propensity-matched patients[J]. Transfusion, 2014, 54(4): 1106-1113.
[2] Pang QY, An R, Liu HL.Perioperative transfusion and the prognosis of colorectal cancer surgery: a systematic review and meta-analysis[J]. World J Surg Oncol, 2019, 17(1): 7.
[3] Xenos ES, Vargas HD, Davenport DL.Association of bloodtransfusion and venous thromboembolism after colorectalcancer resection[J]. Thromb Res, 2012, 129(5):568-572.
[4] Blajchman MA.Allogeneic blood transfusions, immunomodulation, and postoperative bacterial infection: do we have the answers yet?[J]. Transfusion, 1997, 37(2): 121-125.
[5] Cata JP, Wang H, Gottumukkala V, et al.Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions[J]. Br J Anaesth, 2013, 110(5): 690-701.
[6] Stephenson BM.Blood transfusion does not have an adverse effect on survival after operation for colorectal cancer[J]. Ann R Coll Surg Engl, 1993, 75(6): 451.
[7] Silvis R, Steup W, Brand A et al. Protective effect of blood transfusions on postoperative recurrence of Crohn’s disease in parous women[J]. Transfusion, 1994, 34(3): 242-247.
[8] Aquina CT, Blumberg N, Probst CP et al. Large variation in blood transfusion use after colorectal resection: a call to action[J]. Dis Colon Rectum, 2016, 59(5): 411-418.
[9] Narasimhan V, Spychal R, Pilgrim C.Blood transfusions for emergency laparotomies in general surgery[J]. J Acute Care Surg, 2017, 7(1): 15-22.
[10] Usal H, Nabagiez J, Sayad P, Ferzli GS.Cost effectiveness of routine type and screen testing before laparoscopic cholecystectomy[J]. Surg Endosc, 1999, 13(2): 146-147.
[11] Ghirardo SF, Mohan I, Gomensoro A, Chorost MI.Routine preoperative typing and screening: a safeguard or a misuse of resources[J]. JSLS, 2010, 14(3): 395-398.
[12] Ejaz A, Spolverato G, Kim Y et al. Identifying variations in blood use based on hemoglobin transfusion trigger and target among hepatopancreaticobiliary surgeons[J]. J Am Coll Surg, 2014, 219(2): 217-28.
[13] Kim Y, Spolverato G, Lucas DJ et al. Red cell transfusion triggers and postoperative outcomes after major surgery[J]. J Gastrointest Surg, 2015, 19(11): 2062-2073.
[14] Bernard AC, Davenport DL, Chang PKet al. Intraoperative transfusion of 1U to 2U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia,sepsis in general surgery patients [J]. J Am Coll Surg, 2009, 208(5): 931-939.e1-2.
[15] Ikuta S, Miki C, Hatada T et al. Allogenic blood transfusion is an independent risk factor for infective complications after less invasive gastrointestinal surgery[J]. Am J Surg, 2003, 185(3): 188-193.
[16] Jensen L, Hokland M, Nielsen H.A randomized controlled study of the effect of bedside leucocyte depletion on the immunosuppressive effect of whole blood transfusion in patients undergoing elective colorectal surgery[J]. Br J Surg, 1996, 83(7): 973-977.
[17] Vamvakas EC.Platelet transfusion and adverse outcomes[J]. Lancet, 2004, 364(9447): 1736-1738.
[18] Blajchman MA.Allogeneic blood transfusions, immunomodulation, and postoperative bacterial infection: do we have the answers yet?[J]. Transfusion, 1997, 37(2): 121-125.