Tartter P I, Quintero S, Barron D M
Am J Surg. 1986 Nov;152(5):479-82. doi: 10.1016/0002-9610(86)90207-2.
We prospectively studied 168 consecutive patients with colorectal cancer to identify perioperative determinants of infectious complications. All patients received preoperative bowel preparation with laxatives, enemas, oral neomycin and erythromycin base, and intravenous cefazolin. Age, sex, admission hematocrit value, operative procedure, specimen length, duration of operation, blood loss, transfusions, tumor size, tumor differentiation, nodal status, and Dukes' stage were evaluated in relation to infectious complications using multivariate analysis. Infectious complications developed in 24 of the 168 patients in the study (14 percent) and these accounted for the four deaths. Blood transfusion (p = 0.0100) and admission hematocrit value (p = 0.0191) were significantly related to postoperative infectious complications. Low admission hematocrit values appeared to protect patients from infectious complications. Patients who had postoperative infectious complications received 2.14 +/- 2.75 units of blood compared with 0.82 +/- 1.37 units in patients without infectious complications (p = 0.0005). Although blood transfusion was associated with high operative blood loss, prolonged procedures, and large specimens (p less than 0.005), none of these factors was significantly associated with infectious complications (p greater than 0.10). Blood transfusion is immunosuppressive in other clinical situations and may be a more significant factor affecting postoperative immune function and susceptibility to infectious complications than previously recognized.
我们对168例连续性结直肠癌患者进行了前瞻性研究，以确定感染性并发症的围手术期决定因素。所有患者均接受了术前肠道准备，包括使用泻药、灌肠、口服新霉素和红霉素碱以及静脉注射头孢唑林。使用多变量分析评估了年龄、性别、入院时血细胞比容值、手术方式、标本长度、手术持续时间、失血量、输血情况、肿瘤大小、肿瘤分化程度、淋巴结状态和Dukes分期与感染性并发症的关系。该研究中的168例患者中有24例（14%）发生了感染性并发症，这些并发症导致了4例死亡。输血（p = 0.0100）和入院时血细胞比容值（p = 0.0191）与术后感染性并发症显著相关。低入院血细胞比容值似乎能保护患者免受感染性并发症的影响。发生术后感染性并发症的患者接受了2.14±2.75单位的血液，而未发生感染性并发症的患者为0.82±1.37单位（p = 0.0005）。虽然输血与术中大量失血、手术时间延长和标本较大有关（p＜0.005），但这些因素均与感染性并发症无显著相关性（p＞0.10）。在其他临床情况下，输血具有免疫抑制作用，可能是一个比以前认识到的更重要的影响术后免疫功能和感染性并发症易感性的因素。
