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老年患者腰椎手术后围手术期自体输血与术后早期认知功能障碍的相关性

The association of perioperative autologous blood transfusion with the early postoperative cognitive dysfunction in aged patients following lumbar surgery.

作者信息

Xu Xiaohan, Wang Ying, Zhang Jie, Du Yingying, Li Yanna, Xing Na, Wei Xin, Li Zhisong, Wang Zhongyu, Xue Jinhu, Yan Jie, Zhang Wei

机构信息

Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China.

Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Henan, China.

出版信息

Transfus Apher Sci. 2015 Aug;53(1):48-51. doi: 10.1016/j.transci.2015.03.004. Epub 2015 Mar 16.

Abstract

PURPOSE

Intraoperation autologous blood transfusion is an effective method that is used in surgeries with an important blood loss. Several studies suggest that massive blood transfusion is one of the independent risks for postoperative cognitive dysfunction (POCD). Whether the autologous blood is one of the risk factor for POCD or not, we retrospectively examined the incidence of POCD and the probable risk factors in patients undergoing lumbar surgery in our hospital, with the same aged non-POCD patients as controls.

METHODS

Eighty-one patients who underwent lumbar surgery were included. Perioperative data were examined for association with POCD on the 7 postoperative days by a Mini-Mental State Test. Multivariable logistic regression analysis was conducted to determine the probable risks associated with POCD.

RESULTS

POCD was found in 21 patients. Participants who developed POCD were more likely to had a lower eduction level, more likely to had more blood loss, higher incidence of preoperative anemia, and perioperative allogeneic blood transfusion of more than 3 units as independent risk factors for POCD 7 d postoperatively (P < 0.05). Otherwise, there is no significant difference of the patients received autologous blood or not (P > 0.05).

CONCLUSION

Autologous blood transfusion is not a risk factor for POCD in aged patients following lumbar surgery. Autologous blood is likely to be a better method of intraoperative blood transfusion during lumbar spine surgery.

摘要

目的

术中自体输血是一种用于失血量大的手术的有效方法。多项研究表明,大量输血是术后认知功能障碍(POCD)的独立风险因素之一。自体血是否为POCD的风险因素之一,我们回顾性研究了我院接受腰椎手术患者的POCD发生率及可能的风险因素,并以年龄匹配的非POCD患者作为对照。

方法

纳入81例接受腰椎手术的患者。通过简易精神状态检查评估围手术期数据与术后7天POCD的相关性。进行多变量逻辑回归分析以确定与POCD相关的可能风险。

结果

21例患者发生POCD。发生POCD的参与者更有可能教育水平较低、失血更多、术前贫血发生率更高以及围手术期异体输血超过3单位,这些是术后7天POCD的独立风险因素(P<0.05)。否则,接受自体血与否的患者之间无显著差异(P>0.05)。

结论

自体输血不是老年腰椎手术后POCD的风险因素。自体血可能是腰椎手术中更好的术中输血方法。

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