Zhang P, Jiang C Q, Xiong Z G, Zheng Y B, Fu Y F, Li X M, Pang D F, Liao X F, Tong X, Zhu H M, Yang Z H, Gong G W, Yin X P, Li D L, Li H J, Chen H L, Jiang X F, He Z J, Lu Y J, Shuai X M, Gao J B, Cai K L, Tao K X
Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
Zhonghua Wai Ke Za Zhi. 2022 Jan 1;60(1):32-38. doi: 10.3760/cma.j.cn112139-20210405-00160.
To investigate the incidence and treatment of perioperative anemia in patients with gastrointestinal neoplasms in Hubei Province. The clinicopathological data of 7 474 patients with gastrointestinal neoplasms in 62 hospitals in 15 cities (state) of Hubei Province in 2019 were collected in the form of network database. There were 4 749 males and 2 725 females. The median age of the patients was 62 years (range: 17 to 96 years). The hemoglobin value of the first time in hospital and the first day after operation was used as the criterion of preoperative anemia and postoperative anemia. Anemia was defined as male hemoglobin <120 g/L and female hemoglobin <110.0 g/L, mild anemia as 90 to normal, moderate anemia as 60 to <90 g/L, severe anemia as <60 g/L. The test and χ test were used for inter-group comparison. The overall incidence of preoperative anemia was 38.60%(2 885/7 474), and the incidences of mild anemia, moderate anemia and severe anemia were 25.09%(1 875/7 474), 11.37%(850/7 474) and 2.14%(160/7 474), respectively. The overall incidence of postoperative anemia was 61.40%(4 589/7 474). The incidence of mild anemia, moderate anemia and severe anemia were 48.73%(3 642/7 474), 12.20%(912/7 474) and 0.47%(35/7 474), respectively. The proportion of preoperative anemia patients receiving treatment was 26.86% (775/2 885), and the proportion of postoperative anemia patients receiving treatment was 14.93% (685/4 589). The proportions of preoperative anemia patients in grade ⅢA, grade ⅢB, and grade ⅡA hospitals receiving treatment were 26.12% (649/2 485), 32.32% (85/263), and 29.93% (41/137), and the proportions of postoperative anemia patients receiving treatment were 14.61% (592/4 052), 22.05% (73/331), and 9.71% (20/206). The proportion of intraoperative blood transfusion (16.74% (483/2 885) 3.05% (140/4 589), χ²=434.555, <0.01) and the incidence of postoperative complications (17.78% (513/2 885) 14.08% (646/4 589), χ²=18.553, <0.01) in the preoperative anemia group were higher than those in the non-anemia group, and the postoperative hospital stay in the preoperative anemia group was longer than that in the non-anemia group ((14.1±7.3) days (13.3±6.2) days, =5.202, <0.01). The incidence of perioperative anemia in patients with gastrointestinal neoplasms is high. Preoperative anemia can increase the demand for intraoperative blood transfusion and affect the short-term prognosis of patients. At present, the concept of standardized treatment of perioperative anemia among gastrointestinal surgeons in Hubei Province needs to be improved.
为调查湖北省胃肠道肿瘤患者围手术期贫血的发生率及治疗情况。采用网络数据库形式收集2019年湖北省15个市(州)62家医院7474例胃肠道肿瘤患者的临床病理资料。其中男性4749例,女性2725例。患者年龄中位数为62岁(范围:17至96岁)。将患者入院首次及术后第1天的血红蛋白值作为术前贫血和术后贫血的判断标准。贫血定义为男性血红蛋白<120 g/L,女性血红蛋白<110.0 g/L,轻度贫血为90至正常,中度贫血为60至<90 g/L,重度贫血为<60 g/L。采用t检验和χ²检验进行组间比较。术前贫血总发生率为38.60%(2885/7474),轻度贫血、中度贫血和重度贫血发生率分别为25.09%(1875/7474)、11.37%(850/7474)和2.14%(160/7474)。术后贫血总发生率为61.40%(4589/7474)。轻度贫血、中度贫血和重度贫血发生率分别为48.73%(3642/7474)、12.20%(912/7474)和0.47%(35/7474)。术前贫血患者接受治疗的比例为26.86%(775/2885),术后贫血患者接受治疗的比例为14.93%(685/4589)。ⅢA、ⅢB级和ⅡA级医院术前贫血患者接受治疗的比例分别为26.12%(649/2485)、32.32%(85/263)和29.93%(41/137),术后贫血患者接受治疗的比例分别为14.61%(592/4052)、22.05%(73/331)和9.71%(20/206)。术前贫血组术中输血比例(16.74%(483/2885)比3.05%(140/4589),χ²=434.555,P<0.01)和术后并发症发生率(17.78%(513/2885)比14.08%(646/4589),χ²=18.553,P<0.01)高于非贫血组,术前贫血组术后住院时间长于非贫血组((14.1±7.3)天比(13.3±6.2)天,t=5.202,P<0.01)。胃肠道肿瘤患者围手术期贫血发生率高。术前贫血会增加术中输血需求并影响患者短期预后。目前湖北省胃肠外科医生围手术期贫血规范化治疗观念有待提高。