心脏手术患者输血成分与术后感染

Transfusion of blood components and postoperative infection in patients undergoing cardiac surgery.

作者信息

Leal-Noval S R, Rincón-Ferrari M D, García-Curiel A, Herruzo-Avilés A, Camacho-Laraña P, Garnacho-Montero J, Amaya-Villar R

机构信息

Critical Care Division, Hospital Universitario Virgen del Rocío, Seville, Spain.

出版信息

Chest. 2001 May;119(5):1461-8. doi: 10.1378/chest.119.5.1461.

DOI:10.1378/chest.119.5.1461

PMID:11348954

Abstract

OBJECTIVE

To investigate the influence of blood derivatives on the acquisition of severe postoperative infection (SPI) in patients undergoing heart surgery.

SETTING

The postoperative ICUs of a tertiary-level university hospital.

DESIGN

A cohort study.

METHODS

During a 4-year period, 738 patients, classified as patients with SPIs and patients without SPIs (non-SPI patients), were included in the study. We studied the influence of 36 variables on the development of SPI in general and individually for pneumonia, mediastinitis, and/or septicemia. The influence of the blood derivatives on infections was assessed for RBC concentrates, RBC and plasma, and RBC and platelets.

RESULTS

Seventy patients (9.4%) were classified as having SPIs, and 668 (90.6%) were classified as not having SPIs. After multivariate analysis, the variables associated with SPI (incidence, 9.4%) were reintubation, sternal dehiscence, mechanical ventilation (MV) for > or = 48 h, reintervention, neurologic dysfunction, transfusion of > or = 4 U RBCs, and systemic arterial hypotension. The variables associated with nosocomial pneumonia (incidence, 5.9%) were reintubation, MV for > or = 48 h, neurologic dysfunction, transfusion of > or = 4 U blood components, and arterial hypotension. The variables associated with mediastinitis (incidence, 2.3%) were reintervention and sternal dehiscence, and those associated with sepsis (incidence, 1.6%) were reintubation, time of bypass > or = 110 min, and MV for > or = 48 h. The mortality rate (patients with SPI, 52.8%; non-SPI patients, 8.2%; p < 0.001) and mean (+/- SD) length of stay in the ICU (patients with SPI, 15.8 +/- 12.9 days; non-SPI patients, 4.5 +/- 4.4 days; p < 0.001) were greater for the infected patients. The transfused patients also had a greater mortality rate (13.3% vs 8.9%, respectively; p < 0.001) and a longer mean stay in the ICU (6.1 +/- 7.2 days vs 3.7 +/- 2.8 days, respectively; p < 0.01) than those not transfused.

CONCLUSION

The administration of blood derivatives, mainly RBCs, was associated in a dose-dependent manner with the development of SPIs, primarily nosocomial pneumonia.

摘要

目的

探讨血液制品对心脏手术患者术后发生严重感染（SPI）的影响。

背景

一所三级大学医院的术后重症监护病房。

设计

队列研究。

方法

在4年期间，738例患者被纳入研究，分为SPI患者和非SPI患者（非SPI患者）。我们研究了36个变量对SPI总体发生以及对肺炎、纵隔炎和/或败血症个体发生的影响。评估了红细胞浓缩物、红细胞与血浆、红细胞与血小板等血液制品对感染的影响。

结果

70例患者（9.4%）被归类为患有SPI，668例（90.6%）被归类为未患有SPI。多变量分析后，与SPI（发生率9.4%）相关的变量为再次插管、胸骨裂开、机械通气（MV）≥48小时、再次干预、神经功能障碍、输注≥4单位红细胞以及全身性动脉低血压。与医院获得性肺炎（发生率5.9%）相关的变量为再次插管、MV≥48小时、神经功能障碍、输注≥4单位血液成分以及动脉低血压。与纵隔炎（发生率2.3%）相关的变量为再次干预和胸骨裂开，与败血症（发生率1.6%）相关的变量为再次插管、体外循环时间≥110分钟以及MV≥48小时。感染患者的死亡率（SPI患者为52.8%；非SPI患者为8.2%；p<0.001）和在重症监护病房的平均（±标准差）住院时间（SPI患者为15.8±12.9天；非SPI患者为4.5±4.4天；p<0.001）更高。输血患者的死亡率（分别为13.3%和8.9%；p<0.001）和在重症监护病房的平均住院时间（分别为6.1±7.2天和3.7±2.8天；p<0.01）也高于未输血患者。