School of Engineering, University of Michigan, Ann Arbor, Michigan 48109-5864, USA.
Ann Thorac Surg. 2013 Sep;96(3):910-6. doi: 10.1016/j.athoracsur.2013.05.003. Epub 2013 Jul 16.
Blood product transfusion during cardiopulmonary bypass has been demonstrated to be associated with increased morbidity and mortality in adult cardiac surgery populations. The aim of this study was to characterize the risk-adjusted occurrence of postoperative complications and mortality in relation to intraoperative blood product transfusion in our pediatric cardiac surgery population.
A retrospective review was performed on 1,631 consecutive cardiopulmonary bypass cases to determine the effects of intraoperative blood product transfusion on selected outcomes. After adjusting for patient and operative risk factors, multivariate analysis was performed to determine the association between blood product transfusion and postoperative complications. Cox proportional hazards model was used to examine the relationship of packed red blood cell transfusion to hospital length of stay.
Red blood cell and fresh frozen plasma transfusion was associated with pulmonary complications (adjusted odds ratio, 1.55; 95% confidence interval, 1.05 to 2.28; p=0.03). Red blood cell transfusion also correlated with prolonged hospital stay (p<0.01). Cryoprecipate transfusion was associated with postoperative pulmonary complications (adjusted odds ratio, 1.79; 95% confidence interval, 1.13 to 2.55; p=0.01), but decreased incidence of 30-day mortality (adjusted odds ratio, 0.44; 95% confidence interval, 0.23 to 0.85; p=0.02). Platelet transfusion was associated with decreased 30-day mortality (adjusted odds ratio, 0.51; 95% confidence interval, 0.28 to 0.93; p=0.04), but not overall mortality.
Blood product transfusion was associated with an increased incidence of postoperative pulmonary complications and prolonged hospital length of stay, but not overall mortality. These findings suggest that minimizing blood product transfusion would be beneficial in the pediatric cardiopulmonary bypass surgery patient population.
体外循环期间输血已被证明与成人心脏手术人群的发病率和死亡率增加有关。本研究的目的是描述与术中输血相关的术后并发症和死亡率在儿科心脏手术人群中的风险调整发生率。
对 1631 例连续体外循环病例进行回顾性分析，以确定术中输血对选定结果的影响。在调整患者和手术风险因素后，进行多变量分析以确定输血与术后并发症之间的关联。使用 Cox 比例风险模型检查红细胞输注与住院时间的关系。
红细胞和新鲜冰冻血浆的输血与肺部并发症相关（调整后的优势比，1.55；95%置信区间，1.05 至 2.28；p=0.03）。红细胞输血也与住院时间延长相关（p<0.01）。冷沉淀输注与术后肺部并发症相关（调整后的优势比，1.79；95%置信区间，1.13 至 2.55；p=0.01），但降低了 30 天死亡率（调整后的优势比，0.44；95%置信区间，0.23 至 0.85；p=0.02）。血小板输血与降低 30 天死亡率相关（调整后的优势比，0.51；95%置信区间，0.28 至 0.93；p=0.04），但与总体死亡率无关。
输血与术后肺部并发症发生率增加和住院时间延长有关，但与总体死亡率无关。这些发现表明，在儿科体外循环手术患者人群中，尽量减少输血可能是有益的。
