Zuo Yansong, Zhang Han, Lv Lizhi, Li Gang, Zhao Ju, Wang Qiang
Department of Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
Department of Cardiopulmonary Bypass, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
Rev Cardiovasc Med. 2025 Jun 26;26(6):36566. doi: 10.31083/RCM36566. eCollection 2025 Jun.
To investigate the factors that influence blood transfusions after neonatal cardiac surgery and their association with prolonged mechanical ventilation (PMV) to provide a basis for optimizing blood transfusion strategies.
This study retrospectively analyzed the clinical data of 202 neonates who had undergone cardiac surgery with cardiopulmonary bypass (CPB) in Beijing Anzhen Hospital from 2019 to 2023. Demographic data, preoperative parameters (body weight, hemoglobin, Risk-Adjusted Classification of Congenital Heart Surgery 1 (RACHS-1) score), intraoperative data (CPB time, aortic cross-clamp time, deep hypothermic circulatory arrest (DHCA)), and transfusions of red blood cells (RBCs), fresh frozen plasma (FFP), and platelet concentrate (PC) within 48 hours after surgery were collected. PMV was defined as mechanical ventilation ≥96 hours after surgery. Multivariate logistic regression was used to analyze independent risk factors for PMV, and the dose-response relationship between transfusion volume and PMV was evaluated by restricted cubic splines (RCSs).
Within 48 hours postoperation, 50.00% of patients were transfused with RBCs, 37.62% were transfused with FFP, and 27.72% were transfused with PC. The PMV incidence was 36.63% in patients with lower body weight (odds ratio (OR) = 0.38, 95% confidence interval (CI): 0.20-0.74; = 0.005), lower preoperative hemoglobin (OR = 0.99; 95% CI: 0.97-0.99; = 0.041), and a RACHS-1 score of 4 (OR = 2.56; 95% CI: 1.04-6.27; = 0.040), and RBCs (OR = 2.02; 95% CI: 1.02-4.00; = 0.043), and FFP infusion (OR = 1.98; 95% CI: 1.02-3.85; = 0.043) were independent risk factors. The RCS demonstrated a linear dose-response relationship between the volume of RBCs infused and PMV ( nonlinear = 0.668), whereas there was no association for FFP. The duration of intensive care unit (ICU) stay in patients with PMV (14 days vs. 8 days) and the hospitalization (18 days vs. 13 days) were significantly longer (both < 0.001).
Blood transfusion after neonatal cardiac surgery is an important controllable risk factor for the development of PMV, and its risk increases linearly with the volume of RBC transfusion. Future multicenter prospective studies are needed to validate the causal association further.
探讨影响新生儿心脏手术后输血的因素及其与机械通气时间延长（PMV）的关联，为优化输血策略提供依据。
本研究回顾性分析了2019年至2023年在北京安贞医院接受体外循环（CPB）心脏手术的202例新生儿的临床资料。收集人口统计学数据、术前参数（体重、血红蛋白、先天性心脏病手术风险调整分级1（RACHS-1）评分）、术中数据（CPB时间、主动脉阻断时间、深低温停循环（DHCA））以及术后48小时内红细胞（RBC）、新鲜冰冻血浆（FFP）和血小板浓缩物（PC）的输注情况。PMV定义为术后机械通气≥96小时。采用多因素逻辑回归分析PMV的独立危险因素，并通过限制性立方样条（RCS）评估输血量与PMV之间的剂量反应关系。
术后48小时内，50.00%的患者输注了RBC，37.62%的患者输注了FFP，27.72%的患者输注了PC。低体重（比值比（OR）=0.38，95%置信区间（CI）：0.20-0.74；P=0.005）、术前低血红蛋白（OR=0.99；95%CI：0.97-0.99；P=0.041）、RACHS-1评分为4（OR=2.56；95%CI：1.04-6.27；P=0.040）、RBC输注（OR=2.02；95%CI：1.02-4.00；P=0.043）和FFP输注（OR=1.98；95%CI：1.02-3.85；P=0.043）是PMV的独立危险因素。RCS显示输注RBC的量与PMV之间存在线性剂量反应关系（非线性P=0.668），而FFP则无关联。PMV患者的重症监护病房（ICU）住院时间（14天对8天）和住院时间（18天对13天）明显更长（均P<0.001）。
新生儿心脏手术后输血是PMV发生的一个重要可控危险因素，其风险随RBC输血量呈线性增加。未来需要多中心前瞻性研究进一步验证因果关联。
