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Impact of Intraoperative Plasma Infusion Dose on the Clinical Prognosis of Cardiac Surgery Patients
- Journal of Sun Yat-sen University(Medical Sciences) Vol. 45, Issue 3, Pages: 466-474(2024)
- 作者机构：
1.中山大学孙逸仙纪念医院输血科，广东 广州510120
2.中国人民解放军总医院第六医学中心，北京 100048
- 作者简介：
MA Wei； E-mail：langmawei@bjmu.edu.cn
LIU Yiling； E-mail： 190313806@qq.com
- 基金信息：
DOI：10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.20240515.001
CLC： R619.1Published：20 May 2024，
Received：05 March 2024，
Accepted：09 May 2024
扫 描 看 全 文
李丹丹,黄国栋,马伟等.术中血浆输注剂量对心脏外科手术患者临床预后的影响[J].中山大学学报（医学科学版）,2024,45(03):466-474.
LI Dandan,HUANG Guodong,MA Wei,et al.Impact of Intraoperative Plasma Infusion Dose on the Clinical Prognosis of Cardiac Surgery Patients[J].Journal of Sun Yat-sen University(Medical Sciences),2024,45(03):466-474.
李丹丹,黄国栋,马伟等.术中血浆输注剂量对心脏外科手术患者临床预后的影响[J].中山大学学报（医学科学版）,2024,45(03):466-474. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.20240515.001.
LI Dandan,HUANG Guodong,MA Wei,et al.Impact of Intraoperative Plasma Infusion Dose on the Clinical Prognosis of Cardiac Surgery Patients[J].Journal of Sun Yat-sen University(Medical Sciences),2024,45(03):466-474. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.20240515.001.
摘要
目的
2
评估术中血浆输注剂量，凝血实验测试值INR对心脏外科手术患者临床预后的影响，为指导心脏外科手术术中合理用血提供依据。
方法
2
收集中山大学孙逸仙纪念医院2014年1月至2022年12月期间术中输注新鲜冰冻血浆的305例心脏外科手术患者的临床资料，并根据术中血浆输注剂量分为低剂
量组（血浆输注剂量
<
15 mL/kg，
n
=214）和高剂量组（血浆输注剂量≥15 mL/kg，
n
=91）， 并通过单因素，相关性以及Logistic多因素回归分析，探讨血浆输注量，血浆输注前后INR的变化情况与心脏外科手术患者临床预后之间的关系。
结果
2
最终共有305例心脏外科手术患者纳入研究分析，所有患者术中血浆输注剂量的中位数（四分位间距）为11.11（8.17~19.05）mL/kg，其中高剂量组与低剂量组患者术中血浆输注剂量的中位数（四分位间距）分别为17.78（15.69~20.91）mL/kg和9.52（7.77~11.43）mL/kg，两者差异具有统计学意义（
P
<
0.001）。高低剂量组血浆输注前后INR变化值中位数（四分位间距）分别为0.98（0.60~1.26）和0.50（0.35~0.76），两者差异具有统计学意义（
P
<
0.001）。Logistic 多因素回归分析显示，术前INR值的异常升高导致心脏外科手术患者术后24 h内输注红细胞的风险增加（
P
<
0.001），OR 95%CI为6.757（3.068， 14.822），同时也增加手术患者术后住院死亡风险（
P
<
0.001），OR 95%CI为5.441（2.193， 13.499）；术中血浆输注前后INR的改变值降低了心脏外科手术患者术后24 h内输注红细胞的风险（
P
=0.001），OR 95%CI为0.244（0.107， 0.558）。相关性分析显示，术中血浆剂量与心脏外科手术患者术后ICU时间（
r
s
=0.569，
P
<
0.001）和住院时间（
r
s
=0.302，
P
<
0.001）呈正相关。
结论
2
在接受术中血浆输注的心脏外科手术患者中，高血浆输注剂量和术前异常高的INR值与较差的临床预后有关，而输注血浆后INR值校正程度更高的手术患者显示出较好的临床结果。
Abstract
Objective
2
To assess the impact of intraoperative plasma infusion dose and coagulation test value INR on the clinical prognosis of patients undergoing cardiac surgery， providing a basis for guiding rational blood use during cardiac surgery.
Methods
2
The clinical data of 305 surgical patients who received fresh frozen plasma transfusion during cardiac surgery were collected in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2014 to December 2022. The patients were divided into low-dose group （plasma infusion dose
<
15 mL/kg，
n
= 214） and high-dose group （plasma infusion dose ≥15 mL/kg，
n
= 91） based on the intraoperative plasma dose. Univariate analysis， correlation analysis and logistic multivariate regression analysis were used to analyze the relationship between plasma infusion
dose， changes in INR before and after plasma transfusion， and the clinical prognosis of patients undergoing cardiac surgery.
Results
2
The median plasma infusion dose for all patients was 11.11 （8.17-19.05） mL/kg， while the median plasma infusion dose in the high-dose group and the low-dose group was 17.78 （15.69-20.91） mL/kg and 9.52 （7.77-11.43） mL/kg， respectively， with a statistically significant difference （
P
<
0.001）. The median INR decrease in the high-dose and low-dose groups was 0.98 （0.60-1.26） and 0.50 （0.35-0.76）， respectively， with a statistically significant difference （
P
<
0.001）. Logistic multivariate regression analysis revealed that abnormally elevated preoperative INR values increased the risk of postoperative red blood cell transfusion within 24 hours in cardiac surgery patients （
P
<
0.001）， with an OR 95%CI of 6.757（3.068， 14.822）. Additionally， it also increased the risk of postoperative in-hospital mortality （
P
<
0.001）， with an OR 95%CI of 5.441 （2.193， 13.499）. INR decrease reduced the risk of postoperative red blood cell transfusion within 24 hours in cardiac surgery patients （
P
=0.001）， with an OR 95%CI of 0.244（0.107， 0.558）. Correlation analysis showed positive correlation between plasma infusion dose and postoperative ICU days （
r
s
=0.569，
P
<
0.001） and hospital days （
r
s
=0.302，
P
<
0.001） in cardiac surgery patients.
Conclusion
2
Among patients undergoing cardiac surgery who receive intraoperative plasma transfusion， high plasma infusion dose and abnormally elevated preoperative INR values are associated with poorer clinical outcomes， while patients who show a greater degree of INR correction after plasma transfusion exhibit better clinical results.
关键词
血浆剂量心脏外科国际标准化比率红细胞临床预后
Keywords
plasma dosecardiac surgeryINRred blood cellsclinical prognosis
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