术前血栓弹力图作为成人活体肝移植输血需求的预测指标
Preoperative Thromboelastometry as a Predictor of Transfusion Requirements during Adult Living Donor Liver Transplantation.
作者信息
Fayed Nirmeen, Mourad Wessam, Yassen Khaled, Görlinger Klaus
机构信息
Department of Anesthesia, National Liver Institute, Menoufiya University, Shebeen El Kom City, Egypt.
Department of Public Health, Community Medicine and Statistics, National Liver Institute, Menoufiya University, Shebeen El Kom City, Egypt.
出版信息
Transfus Med Hemother. 2015 Mar;42(2):99-108. doi: 10.1159/000381733. Epub 2015 Mar 31.
BACKGROUND
The ability to predict transfusion requirements may improve perioperative bleeding management as an integral part of a patient blood management program. Therefore, the aim of our study was to evaluate preoperative thromboelastometry as a predictor of transfusion requirements for adult living donor liver transplant recipients.
METHODS
The correlation between preoperative thromboelastometry variables in 100 adult living donor liver transplant recipients and intraoperative blood transfusion requirements was examined by univariate and multivariate linear regression analysis. Thresholds of thromboelastometric parameters for prediction of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate transfusion requirements were determined with receiver operating characteristics analysis. The attending anesthetists were blinded to the preoperative thromboelastometric analysis. However, a thromboelastometry-guided transfusion algorithm with predefined trigger values was used intraoperatively. The transfusion triggers in this algorithm did not change during the study period.
RESULTS
Univariate analysis confirmed significant correlations between PRBCs, FFP, platelets or cryoprecipitate transfusion requirements and most thromboelastometric variables. Backward stepwise logistic regression indicated that EXTEM coagulation time (CT), maximum clot firmness (MCF) and INTEM CT, clot formation time (CFT) and MCF are independent predictors for PRBC transfusion. EXTEM CT, CFT and FIBTEM MCF are independent predictors for FFP transfusion. Only EXTEM and INTEM MCF were independent predictors of platelet transfusion. EXTEM CFT and MCF, INTEM CT, CFT and MCF as well as FIBTEM MCF are independent predictors for cryoprecipitate transfusion. Thromboelastometry-based regression equation accounted for 63% of PRBC, 83% of FFP, 61% of cryoprecipitate, and 44% of platelet transfusion requirements.
CONCLUSION
Preoperative thromboelastometric analysis is helpful to predict transfusion requirements in adult living donor liver transplant recipients. This may allow for better preparation and less cross-matching prior to surgery. The findings of our study need to be re-validated in a second prospective patient population.
背景
预测输血需求的能力作为患者血液管理计划的一个组成部分，可能会改善围手术期出血管理。因此，我们研究的目的是评估术前血栓弹力图作为成人活体肝移植受者输血需求预测指标的价值。
方法
通过单因素和多因素线性回归分析，研究100例成人活体肝移植受者术前血栓弹力图变量与术中输血需求之间的相关性。采用受试者工作特征分析确定预测红细胞悬液（PRBC）、新鲜冰冻血浆（FFP）、血小板和冷沉淀输血需求的血栓弹力图参数阈值。主麻医生对术前血栓弹力图分析结果不知情。然而，术中使用了具有预定义触发值的血栓弹力图指导输血算法。在研究期间，该算法中的输血触发值未发生变化。
结果
单因素分析证实PRBC、FFP、血小板或冷沉淀输血需求与大多数血栓弹力图变量之间存在显著相关性。向后逐步逻辑回归表明，EXTEM凝血时间（CT）、最大凝血硬度（MCF）以及INTEM CT、凝血形成时间（CFT）和MCF是PRBC输血的独立预测指标。EXTEM CT、CFT和FIBTEM MCF是FFP输血的独立预测指标。只有EXTEM和INTEM MCF是血小板输血的独立预测指标。EXTEM CFT和MCF、INTEM CT、CFT和MCF以及FIBTEM MCF是冷沉淀输血的独立预测指标。基于血栓弹力图的回归方程分别解释了PRBC输血需求的63%、FFP输血需求的83%、冷沉淀输血需求的61%和血小板输血需求的44%。
结论
术前血栓弹力图分析有助于预测成人活体肝移植受者的输血需求。这可能有助于在手术前做好更好的准备并减少交叉配血。我们研究的结果需要在另一组前瞻性患者中重新验证。
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