Magovern J A, Sakert T, Benckart D H, Burkholder J A, Liebler G A, Magovern G J, Magovern G J
Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
Ann Thorac Surg. 1996 Jan;61(1):27-32. doi: 10.1016/0003-4975(95)00808-X.
Blood conservation has become an important issue in cardiac surgery. This study was undertaken to determine if the need of blood transfusion could be predicted from preoperative patient variables.
From January 1, 1992, to December 31, 1993, 2,033 patients having isolated coronary artery bypass grafting procedures were studied; 1,446 (71%) were male and 587 (29%), female. The mean age was 65.1 +/- 9.9 years (range, 31 to 88 years). Emergency operation, urgent operation, and reoperations were done in 78 (4%), 188 (9%), and 189 (9%) patients, respectively. In the entire group, 1,245 (61%) received transfusion during hospitalization, and 788 (39%) did not. Logistic regression analysis was used to construct a model that predicted the need of transfusion of packed red blood cells after coronary artery bypass grafting. A transfusion risk score was constructed by assigning points to independent predictive factors on the basis of the logistic regression coefficient and the odds ratio. Preoperative predictors of transfusion were emergency operation, urgent operation, cardiogenic shock, catheterization-induced coronary occlusion, low body mass index, left ventricular ejection fraction lower than 0.30, age greater than 74 years, female sex, low red cell mass, peripheral vascular disease, insulin-dependent diabetes, creatinine level greater than 1.8 mg/dL, albumin value lower than 4 g/dL, and redo operation.
The mean transfusion risk score for patients receiving 0, 1 to 4, and greater than 4 units of packed red blood cells was 2.3 +/- 0.9, 5.2 +/- 3.0, and 9.6 +/- 3.5, respectively (p = 0.001). Patients with a score higher than 6 had a 95% transfusion incidence. The predictive model was validated on 422 patients having coronary artery bypass grafting from January 1 to May 31, 1994. The observed rates of the validation group fell within the 95% confidence intervals of the predicted rates.
These data demonstrate that readily available patient variables can predict patients at risk for transfusion. Routine use of aprotinin and other adjustments of cardiopulmonary bypass should be considered to reduce transfusion in high-risk patients.
血液保护已成为心脏手术中的一个重要问题。本研究旨在确定是否可以根据术前患者变量预测输血需求。
对1992年1月1日至1993年12月31日期间接受单纯冠状动脉旁路移植术的2033例患者进行了研究；其中男性1446例（71%），女性587例（29%）。平均年龄为65.1±9.9岁（范围为31至88岁）。急诊手术、限期手术和再次手术分别在78例（4%）、188例（9%）和189例（9%）患者中进行。在整个研究组中，1245例（61%）患者在住院期间接受了输血，788例（39%）未接受输血。采用逻辑回归分析构建一个模型，以预测冠状动脉旁路移植术后输注浓缩红细胞的需求。根据逻辑回归系数和比值比为独立预测因素赋予分值，构建输血风险评分。输血的术前预测因素包括急诊手术、限期手术、心源性休克、导管插入术引起的冠状动脉闭塞、低体重指数、左心室射血分数低于0.30、年龄大于74岁、女性、低红细胞量、外周血管疾病、胰岛素依赖型糖尿病、肌酐水平大于1.8mg/dL、白蛋白值低于4g/dL以及再次手术。
接受0、1至4以及超过4单位浓缩红细胞的患者，其平均输血风险评分分别为2.3±0.9、5.2±3.0和9.6±3.5（p=0.001）。评分高于6的患者输血发生率为95%。该预测模型在1994年1月1日至5月31日接受冠状动脉旁路移植术的422例患者中得到验证。验证组的观察发生率落在预测发生率的95%置信区间内。
这些数据表明，易于获得的患者变量可以预测有输血风险的患者。应考虑常规使用抑肽酶及对体外循环进行其他调整，以减少高危患者的输血。
