输血预示着接受全主动脉弓置换术的急性 Stanford A 型主动脉夹层患者机械通气时间延长。
Blood Transfusion Predicts Prolonged Mechanical Ventilation in Acute Stanford Type A Aortic Dissection Undergoing Total Aortic Arch Replacement.
作者信息
Xie Qiang, Li Chengnan, Zhong Yongliang, Luo Congcong, Guo Rutao, Liu Yongmin, Zheng Jun, Ge Yipeng, Sun Lizhong, Zhu Junming
机构信息
Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
出版信息
Front Cardiovasc Med. 2022 Apr 15;9:832396. doi: 10.3389/fcvm.2022.832396. eCollection 2022.
BACKGROUND
This research aimed to evaluate the impacts of transfusing packed red blood cells (pRBCs), fresh frozen plasma (FFP), or platelet concentrate (PC) on postoperative mechanical ventilation time (MVT) in patients with acute Stanford type A aortic dissection (ATAAD) undergoing after total arch replacement (TAR).
METHODS
The clinical data of 384 patients with ATAAD after TAR were retrospectively collected from December 2015 to October 2017 to verify whether pRBCs, FFP, or PC transfusion volumes were associated with postoperative MVT. The logistic regression was used to assess whether blood products were risk factors for prolonged mechanical ventilation (PMV) in all three endpoints (PMV ≥24 h, ≥48 h, and ≥72 h).
RESULTS
The mean age of 384 patients was 47.6 ± 10.689 years, and 301 (78.39%) patients were men. Median MVT was 29.5 (4-574) h (h), and 213 (55.47%), 136 (35.42%), and 96 (25.00%) patients had PMV ≥24 h, ≥48 h, and ≥72 h, respectively. A total of 36 (9.38%) patients did not have any blood product transfusion, the number of patients with transfusion of pRBCs, FFP, and PC were 334 (86.98%), 286 (74.48%), and 189 (49.22%), respectively. According to the multivariate logistic regression of three PMV time-endpoints, age was a risk factor [PMV ≥ 24 h odds ratio ( ) = 1.045, = 0.005; = 1.060, = 0.002; = 1.051, = 0.011]. pRBC transfusion ( = 1.156, = 0.001; = 1.156, < 0.001; = 1.135, ≤ 0.001) and PC transfusion ( = 1.366, = 0.029; = 1.226, = 0.030; = 1.229, = 0.011) were independent risk factors for PMV. FFP had no noticeable effect on PMV [ = 0.999, 95% confidence interval () 0.998-1.000, = 0.039; = 0.999, 95% : 0.998-1.000, = 0.025].
CONCLUSIONS
In patients with ATAAD after TAR, the incidence of PMV was very high. Blood products transfusion was closely related to postoperative mechanical ventilation time. pRBC and PC transfusions and age increased the incidence of PMV at all three endpoints.
背景
本研究旨在评估输注浓缩红细胞（pRBC）、新鲜冰冻血浆（FFP）或血小板浓缩液（PC）对接受全弓置换术（TAR）的急性Stanford A型主动脉夹层（ATAAD）患者术后机械通气时间（MVT）的影响。
方法
回顾性收集2015年12月至2017年10月384例TAR术后ATAAD患者的临床资料，以验证pRBC、FFP或PC的输血量是否与术后MVT相关。采用逻辑回归分析评估在所有三个终点（PMV≥24小时、≥48小时和≥72小时）时血液制品是否为机械通气时间延长（PMV）的危险因素。
结果
384例患者的平均年龄为47.6±10.689岁，301例（78.39%）为男性。MVT中位数为29.5（4 - 574）小时，分别有213例（55.47%）、136例（35.42%）和96例（25.00%）患者的PMV≥过24小时、≥48小时和≥72小时。共有36例（9.38%）患者未接受任何血液制品输注，输注pRBC、FFP和PC的患者人数分别为334例（86.98%）、286例（74.48%）和189例（49.22%）。根据三个PMV时间终点的多因素逻辑回归分析，年龄是一个危险因素[PMV≥24小时比值比（OR）=1.045，P = 0.005；PMV≥48小时OR = 1.060，P = 0.002；PMV≥72小时OR = 1.051，P = 0.011]。输注pRBC（PMV≥24小时OR = 1.156，P = 0.001；PMV≥48小时OR = 1.156，P < 0.001；PMV≥72小时OR = 1.135，P≤0.001）和PC（PMV≥24小时OR = 1.366，P = 0.029；PMV≥48小时OR = 1.226，P = 0.030；PMV≥72小时OR = 1.229，P = 0.011）是PMV的独立危险因素。FFP对PMV无显著影响[PMV≥24小时OR = 0.999，95%置信区间（CI）0.998 - 1.000，P = 0.039；PMV≥48小时OR = 0.999，95%CI：0.998 - 1.000，P = 0.025]。
结论
在TAR术后的ATAAD患者中，PMV的发生率非常高。血液制品输注与术后机械通气时间密切相关。输注pRBC和PC以及年龄增加了所有三个终点的PMV发生率。
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