Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, 107th Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China.
Department of Maxillofacial Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, 19th Nonglinxia Road, Guangzhou, Guangdong, 510080, China.
BMC Oral Health. 2024 May 24;24(1):606. doi: 10.1186/s12903-024-04302-w.
Patients undergoing oral and maxillofacial flap reconstruction often need blood transfusions due to massive blood loss. With the increasing limitations of allogeneic blood transfusion (ABT), doctors are considering acute normovolemic hemodilution (ANH) because of its advantages. By comparing the differences in the (Δ) blood indices and postoperative complications of patients receiving ABT or ANH during the reconstruction and repair of oral and maxillofacial tumor flaps, this study's purpose was to provide a reference for the clinical application of ANH.
The clinical data of 276 patients who underwent oral and maxillofacial flap reconstruction from September 25, 2017, to October 11, 2021, in the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, were retrospectively analyzed. According to the intraoperative blood transfusion mode, the patients were divided into two groups: ABT and ANH. The differences in the (Δ) blood indices and the incidence of postoperative complications between the groups were analyzed.
Among the 276 patients who had ANH (124/276) and ABT (152/276), there were no differences in (Δ) Hb, (Δ) PT, or (Δ) FIB (P > 0.05), while (Δ) WBC, (Δ) PLT, (Δ) APTT and (Δ) D-dimer were significantly different (P < 0.05). The blood transfusion method was not an independent factor for flap crisis (P > 0.05). The wound infection probability in patients with high post-PTs was 1.953 times greater than that in patients with low post-PTs (OR = 1.953, 95% CI: 1.232 ∼ 3.095, P = 0.004). A normal or overweight BMI was a protective factor for pulmonary infection, and the incidence of pulmonary infection in these patients was only 0.089 times that of patients with a low BMI (OR = 0.089, 95% CI: 0.017 ∼ 0.462). Moreover, a high ASA grade promoted the occurrence of pulmonary infection (OR = 6.373, 95% CI: 1.681 ∼ 24.163). The blood transfusion mode (B = 0.310, β = 0.360, P < 0.001; ANH: ln hospital stay = 2.20 ± 0.37; ABT: ln hospital stay = 2.54 ± 0.42) improved the length of hospital stay.
Preoperative and postoperative blood transfusion (Δ) Hb, (Δ) PT, and (Δ) FIB did not differ; (Δ) WBC, (Δ) PLT, (Δ) APTT, and (Δ) D-dimer did differ. There was no difference in the effects of the two blood transfusion methods on flap crisis, incision infection or lung infection after flap reconstruction, but ANH resulted in a 3.65 day shorter average hospital stay than did ABT.
口腔颌面部皮瓣重建术患者常因大量失血而需要输血。随着异体输血（ABT）限制的增加，医生开始考虑采用急性等容血液稀释（ANH），因其具有优势。本研究通过比较接受 ABT 或 ANH 的患者在口腔颌面部肿瘤皮瓣重建和修复期间（Δ）血液指标和术后并发症的差异，为 ANH 的临床应用提供参考。
回顾性分析 2017 年 9 月 25 日至 2021 年 10 月 11 日中山大学孙逸仙纪念医院口腔颌面外科收治的 276 例行口腔颌面部皮瓣重建患者的临床资料。根据术中输血方式，将患者分为 ABT 组和 ANH 组。分析两组（Δ）血液指标及术后并发症的差异。
在接受 ANH（124/276）和 ABT（152/276）的 276 例患者中，（Δ）Hb、（Δ）PT 或（Δ）FIB 无差异（P>0.05），而（Δ）WBC、（Δ）PLT、（Δ）APTT 和（Δ）D-二聚体有显著差异（P<0.05）。输血方式不是皮瓣危象的独立因素（P>0.05）。高 post-PTs 患者的切口感染概率是低 post-PTs 患者的 1.953 倍（OR=1.953，95%CI：1.2323.095，P=0.004）。正常或超重 BMI 是肺部感染的保护因素，这些患者的肺部感染发生率仅为低 BMI 患者的 0.089 倍（OR=0.089，95%CI：0.0170.462）。此外，较高的 ASA 分级促进了肺部感染的发生（OR=6.373，95%CI：1.681~24.163）。输血方式（B=0.310，β=0.360，P<0.001；ANH：ln 住院时间=2.20±0.37；ABT：ln 住院时间=2.54±0.42）改善了住院时间。
术前和术后输血（Δ）Hb、（Δ）PT 和（Δ）FIB 无差异；（Δ）WBC、（Δ）PLT、（Δ）APTT 和（Δ）D-二聚体有差异。两种输血方法对皮瓣危象、皮瓣重建后切口感染或肺部感染的影响无差异，但 ANH 比 ABT 平均住院时间缩短 3.65 天。
