Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, Cleveland, OH 44195, USA.
Can J Anaesth. 2013 Aug;60(8):761-70. doi: 10.1007/s12630-013-9937-3. Epub 2013 Apr 23.
Massive transfusion is associated with high morbidity and mortality, yet existing reports of massive transfusion are limited. Our primary aim was to determine the incidence of complications and 30-day mortality among patients who received massive transfusions and to explore risk factors associated with 30-day mortality.
We evaluated 971,455 patients from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We assessed the associations between 30-day mortality and baseline, intraoperative, and postoperative factors among 5,143 patients who received massive transfusions and for whom complete data were available.
The crude 30-day postoperative mortality of the non-transfused, low transfusion (1-4 units), and massive transfusion (≥ 5 units) patients in the NSQIP was 1.2%, 8.9%, and 21.5%, respectively. Of the 5,143 massive transfusion patients with non-missing covariable data, 17% (95% confidence interval [CI] 16% to 18%) died within 30 days of surgery, while 54% (95% CI 53% to 56%) had at least one non-fatal major complication. The following baseline and intraoperative variables were independently associated with 30-day mortality after adjusting for multiple testing: age, American Society of Anesthesiologists (ASA) physical status, emergency case, surgical types, coma > 24 hr before surgery, systemic sepsis, preoperative international normalized ratio of prothrombin time, the number of intraoperative transfusions, and requirement of postoperative transfusion.
Massive transfusion is associated with substantial risk for respiratory and infectious complications and for mortality. Patients who died within 30 days of a massive perioperative transfusion were generally older, more likely to have vascular surgical procedure and abnormal international normalized ratio of prothrombin time, higher ASA physical status, preoperative coma and sepsis, and higher postoperative bleeding requiring transfusion, and they were likely given more intraoperative red cell units.
大量输血与高发病率和死亡率相关，但目前对大量输血的报告有限。我们的主要目的是确定接受大量输血的患者的并发症发生率和 30 天死亡率，并探讨与 30 天死亡率相关的危险因素。
我们评估了美国外科医师学会全国手术质量改进计划（NSQIP）数据库中的 971455 例患者。我们评估了 5143 例接受大量输血且数据完整的患者中，30 天死亡率与基线、术中及术后因素之间的关系。
在 NSQIP 中，未输血、低输血（1-4 单位）和大量输血（≥5 单位）患者的术后 30 天死亡率分别为 1.2%、8.9%和 21.5%。在 5143 例有非缺失协变量数据的大量输血患者中，17%（95%置信区间[CI] 16%至 18%）在术后 30 天内死亡，而 54%（95% CI 53%至 56%）至少发生了 1 种非致命性主要并发症。在调整了多项检验后，以下基线和术中变量与 30 天死亡率独立相关：年龄、美国麻醉医师协会（ASA）身体状况、急诊手术、手术类型、术前昏迷超过 24 小时、全身败血症、术前凝血酶原时间国际标准化比值、术中输血次数和术后输血需求。
大量输血与呼吸和感染并发症及死亡率密切相关。在接受大量围手术期输血后 30 天内死亡的患者通常年龄较大，更可能接受血管外科手术和异常的凝血酶原时间国际标准化比值、更高的 ASA 身体状况、术前昏迷和败血症以及更高的术后需要输血的出血，并且他们可能接受了更多的术中红细胞单位。
