Székely Andrea, Cserép Zsuzsanna, Sápi Erzsébet, Breuer Tamás, Nagy Csaba A, Vargha Péter, Hartyánszky István, Szatmári András, Treszl András
Department of Pediatric Anaesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.
Ann Thorac Surg. 2009 Jan;87(1):187-97. doi: 10.1016/j.athoracsur.2008.09.079.
Blood transfusion in adults is associated with increased mortality and morbidity after cardiac operations. The aim of this study was to identify the main predictors of blood transfusion and explore the relationship between blood transfusion and adverse outcomes in a pediatric population.
We retrospectively analyzed a prospectively collected database (January 2002 to December 2003) of 657 consecutive pediatric patients undergoing open heart procedures in a tertiary pediatric cardiac center. Risk models were calculated for each blood product and for the total amount of blood transfused during the operation and in the first 24 hours. Postoperative adverse events were investigated after propensity score adjustment.
During the postoperative period, 30 patients (4.6%) died, 80 (12.2%) sustained nonvascular pulmonary complications, and 113 (17.2%) had infection. The risk model for the total amount of blood transfusion included weight, preoperative creatinine clearance, preoperative mechanical ventilation, duration of operation and cross-clamp, surgeon, delayed chest closure, inotropic dose, and nitric oxide administration. Univariate analyses demonstrated significant associations between blood transfusion and occurrence of every complication except of neurologic events. After adjustment for propensity score and disease severity, the total amount of blood transfusion was independently associated with an increased risk for infections (odds ratio, 1.01; 95% confidence interval, 1.002 to 1.02; p = 0.01). Transfusion of platelets was associated with lower incidence of nonvascular pulmonary complications (odds ratio, 0.89; 95% confidence interval, 0.79 to 0.99; p = 0.049).
The amount of blood transfusion is independently associated with infections but not with mortality.
成人输血与心脏手术后死亡率和发病率增加相关。本研究的目的是确定儿科人群输血的主要预测因素，并探讨输血与不良结局之间的关系。
我们回顾性分析了一个前瞻性收集的数据库（2002年1月至2003年12月），该数据库包含一家三级儿科心脏中心连续657例接受心脏直视手术的儿科患者。计算了每种血液制品以及手术期间和术后24小时内输血总量的风险模型。在倾向评分调整后调查术后不良事件。
术后期间，30例患者（4.6%）死亡，80例（12.2%）发生非血管性肺部并发症，113例（17.2%）发生感染。输血总量的风险模型包括体重、术前肌酐清除率、术前机械通气、手术和主动脉阻断时间、外科医生、延迟关胸、血管活性药物剂量和一氧化氮使用情况。单因素分析表明，除神经系统事件外，输血与每种并发症的发生之间均存在显著关联。在调整倾向评分和疾病严重程度后，输血总量与感染风险增加独立相关（比值比，1.01；95%置信区间，1.002至1.02；p = 0.01）。输注血小板与非血管性肺部并发症发生率较低相关（比值比，0.89；95%置信区间，0.79至0.99；p = 0.049）。
输血量与感染独立相关，但与死亡率无关。
