围术期输血与心脏外科患者术后感染的关系
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摘要
目的研究围术期输血量与心脏外科患者术后感染的关系。方法采取回顾性分析病例的方法,选取2014年1月~2015年8月入住我院心外科并接受心外科手术治疗的患者共637例,采用单因素和多因素分析方法 ,通过校正混杂因素的影响,判断围术期输血与术后感染的关系。结果输血患者术后感染率显著高于未输血患者(P<0.01)。在校正了混杂因素后,输血与未输血的患者发生术后感染的OR值为1.129(P<0.01)。结论输血是可能导致术后感染的独立危险因素,且输血量越多,术后感染率越高,值得临床关注。
Objective To study the relationship between perioperative blood transfusion amount and postoperative infection in patients of department of cardiac surgery. Methods The method of retrospectively analyzed cases was used.637 patients treated by cardial surgery in department of cardiac surgery of our hospital from January 2014 to August2015 were selected.Single factor and multifactor analysis method was used and the impact of confounding factors were corrected to judge the relationship between perioperative blood transfusion and postoperative infection. Results The postoperative infection rate in patients with blood transfusion was obviously higher than that of patients having no blood transfusion(P <0.01).After corrected the confounding factors,the OR value of postoperative infection in patients with blood transfusion and having no blood transfusion was 1.129(P<0.01). Conclusion Blood transfusion is a dependent risk factors that may lead to postoperative infection,and with more blood transfusion,the higher rate that appears postoperative infection.It is worthy of clinical attention.
Objective To study the relationship between perioperative blood transfusion amount and postoperative infection in patients of department of cardiac surgery. Methods The method of retrospectively analyzed cases was used.637 patients treated by cardial surgery in department of cardiac surgery of our hospital from January 2014 to August2015 were selected.Single factor and multifactor analysis method was used and the impact of confounding factors were corrected to judge the relationship between perioperative blood transfusion and postoperative infection. Results The postoperative infection rate in patients with blood transfusion was obviously higher than that of patients having no blood transfusion(P <0.01).After corrected the confounding factors,the OR value of postoperative infection in patients with blood transfusion and having no blood transfusion was 1.129(P<0.01). Conclusion Blood transfusion is a dependent risk factors that may lead to postoperative infection,and with more blood transfusion,the higher rate that appears postoperative infection.It is worthy of clinical attention.
引文
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[2]祝利华,张伟文,王舜尧,等.心脏外科手术后下呼吸道感染的高危因素分析[J].实用医学杂志,2010,26(8):1379-1380.
[3]刘苏,陈淑敏,李晓恒,等.10年心脏手术后感染调查分析[J].中华医院感染学杂志,2003,13(5):433-435.
[4]Hill GE,Frawley WH,Griffith KE,et al.Allogeneic blood transfusion increases the risk of postoperative bacterial infection:a meta-analysis[J].J Trauma,2003,54(5):908-914.
[5]Banbury MK,Brizzio ME,Rajeswaran J,et al.Transfusion increases the risk of postoperative infection after cardiovascular surgery[J].J Am Coll Surg,2006,202(1):131-138.
[6]Walz JM,Paterson CA,Seligowski JM,et al.Surgical site infection following bowel surgery:a retrospective analysis of1446 patients[J].Arch Surg,2006,141(10):1014-1018.
[7]Tartter PI,Quintero S,Barron DM.Perioperative blood transfusion associated with infectious complications after colorectal cancer operations[J].Am J Surg,1986,152(5):479-482.
[8]刘景汉,欧阳锡林.去白细胞输血基础和临床应用研究进展[J].中国输血杂志,2001,14(4):252-255.
[9]Klos M,Korsak J.Immunomodulatory effect of blood components transfusions[J].Pol Merkur Lekarski,2002,13(77):413-416.
[10]Osman HK,Peiris JS,Taylor CE,et al."Cy tomegalovirus disease"in renal allograft recipients:is human herpesvirus7 a co-factor for disease progression?[J].J Med Virol,1996,48(4):295-301.
[11]Nielsen HJ,Reimert CM,Dybkjaer E,et al.Bioactive substance accumulation and septic complications in a burn trauma patient:effect of perioperative blood transfusion?[J].Burns,1997,23(1):59-63.
[12]刘正敏,高新谱,韩雪莹.不同储存时间后过滤白细胞对浓缩红细胞临床疗效的影响[J].中国输血杂志,2003,16(3):182-183.
[13]符晓阳,袁记,杨金华.胃肠道肿瘤患者围手术期输血与术后感染的关系[J].河南外科学杂志,2005,11(1):45.
[14]Lu JC,Grayson AD,Jha P,et al.Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery[J].Eur J Cardiothorac Surg,2003,23(6):943-949.
[15]Grossi EA,Culliford AT,Krieger KH,et al.A survey of 77major infectious complications of median sternotomy:a review of 7,949 consecutive operative procedures[J].Ann Thorac Surg,1985,40(3):214-223.
[16]周晔,刘冰,王建华,等.心脏外科重症监护病房患者医院感染鲍氏不动杆菌及耐药性分析[J].中华医院感染学杂志,2010,20(5):725-726.
[17]Moskowitz DM,Klein JJ,Shander A,et al.Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center[J].Ann Thorac Surg,2004,77(2):626-634.
[18]Purkayastha S,Athanasiou T,Malinovski V,et al.Does clopidogrel affect outcome after coronary artery bypass grafting?A meta-analysis[J].Heart,2006,92(4):531-532.
[19]Eisen A,Giugliano RP.Antiplatelet and anticoagulation treatment in patients with non ST-segment elevation acute coronary syndrome:comparison of the updated North American and European guidelines[J].Cardiol Rev,2015.[Epub ahead of print]
[20]Barbieri L,Pergolini P,Verdoia M,et al.Platelet reactivity in patients with impaired renal function receiving dual antiplatelet therapy with clopidogrel or ticagrelor[J].Vascul Pharmacol,2015,11(1):31-36.
[21]Ratliff TM,Hodge AB,Preston TJ,et al.Bloodless pediatric cardiopulmonary bypass for a 3.2-kg patient whose parents are of Jehovah′s Witness faith[J].J Extra Corpor Technol,2014,46(2):173-176.
[22]Durandy Y.Perfusionist strategies for blood conservation in pediatric cardiac surgery[J].World J Cardiol,2010,2(2):27-33.
[23]Corwin HL,Gettinger A,Fabian TC,et al.Efficacy and safety of epoetin alfa in critically ill patients[J].N Engl J Med,2007,357(10):965-976.
[24]Schved JF.Preoperative autologous blood donation:a therapy that needs to be scientifically evaluated[J].Transfus Clin Biol,2005,12(5):365-369.
[25]Mondal NK,Sorensen EN,Pham SM,et al.Systemic inflammatory response syndrome in end-stage heart failure patients following continuous-flow left ventricular assist device implantation:differences in plasma redox status and leukocyte activation[J].Artif Organs,2015,22(2):89-91.
[26]Chryssos A,Stroup SJ,Pifer MM,et al.Management of heparin-resistant patients with benefits Maximizing biocompatibility in cardiopulmonary bypass:combining ATrynR recombinant antithrombinⅢand Carmeda R heparinbonded perfusion circuits:a case series[J].J Extra Corpor Technol,2015,47(1):44-47.
[27]Aldea GS,Doursounian M,O′Gara P,et al.Heparin-bonded circuits with a reduced anticoagulation protocol in primary CABG:a prospective,randomized study[J].Ann Thorac Surg,1996,62(2):410-417.
[28]Gunaydin S,Farsak B,Mccusker K,et al.Clinical and biomaterial evaluation of hyaluronan-based heparin-bonded extracorporeal circuits with reduced versus full systemic anticoagulation in reoperation for coronary revascularization[J].J Cardiovasc Med(Hagerstown),2009,10(2):135-142.
[29]Ferraris VA,Ferraris SP,Saha SP,et al.Perioperative blood transfusion and blood conservation in cardiac surgery:the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline[J].Ann Thorac Surg,2007,83(5 Suppl):S27-S86.
[30]Balachandran S,Cross MH,Karthikeyan S,et al.Retrograde autologous priming of the cardiopulmonary bypass circuit reduces blood transfusion after coronary artery surgery[J].Ann Thorac Surg,2002,73(6):1912-1918.
[31]Ranucci M,Biagioli B,Scolletta S,et al.Lowest hematocrit on cardiopulmonary bypass impairs the outcome in coronary surgery:an Italian multicenter study from the National Cardioanesthesia Database[J].Tex Heart Inst J,2006,33(3):300-305.
[32]Habib RH,Zacharias A,Schwann TA,et al.Adverse effects of low hematocrit during cardiopulmonary bypass in the adult:should current practice be changed?[J].J Thorac Cardiovasc Surg,2003,125(6):1438-1450.
[33]Fergusson DA,Hebert PC,Mazer CD,et al.A comparison of aprotinin and lysine analogues in high-risk cardiac surgery[J].N Engl J Med,2008,358(22):2319-2331.
[34]Myles PS,Thompson G,Fedorow C,et al.Evaluation of differences in patient and physician perception of benefit and risks of aspirin and antifibrinolytic therapy in cardiac surgery[J].Anaesth Intensive Care,2014,42(5):592-598.
[35]Vander S T,Kaur S,Lancey R A,et al.Reduction of bleeding after heart operations through the prophylactic use of epsilon-aminocaproic acid[J].J Thorac Cardiovasc Surg,1996,112(4):1098-1107.
[36]Huang F,Wu Y,Yin Z,et al.A systematic review and metaanalysis of the use of antifibrinolytic agents in total hip arthroplasty[J].Hip Int,2015,25(6):502-509.
[37]Mongan PD,Brown RS,Thwaites BK.Tranexamic acid and aprotinin reduce postoperative bleeding and transfusions during primary coronary revascularization[J].Anesth Analg,1998,87(2):258-265.
[38]Eaton MP.Antifibrinolytic therapy in surgery for congenital heart disease[J].Anesth Analg,2008,106(4):1087-1100.
[39]Ichikawa J,Kodaka M,Kitahara T,et al.The use of thromboelastometry and tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery under cardiopulmonary bypass[J].Masui,2015,64(2):131-138.
[40]Koscielny J,von Tempelhoff GF,Ziemer S,et al.A practical concept for preoperative management of patients with impaired primary hemostasis[J].Clin Appl Thromb Hemost,2004,10(2):155-166.
[2]祝利华,张伟文,王舜尧,等.心脏外科手术后下呼吸道感染的高危因素分析[J].实用医学杂志,2010,26(8):1379-1380.
[3]刘苏,陈淑敏,李晓恒,等.10年心脏手术后感染调查分析[J].中华医院感染学杂志,2003,13(5):433-435.
[4]Hill GE,Frawley WH,Griffith KE,et al.Allogeneic blood transfusion increases the risk of postoperative bacterial infection:a meta-analysis[J].J Trauma,2003,54(5):908-914.
[5]Banbury MK,Brizzio ME,Rajeswaran J,et al.Transfusion increases the risk of postoperative infection after cardiovascular surgery[J].J Am Coll Surg,2006,202(1):131-138.
[6]Walz JM,Paterson CA,Seligowski JM,et al.Surgical site infection following bowel surgery:a retrospective analysis of1446 patients[J].Arch Surg,2006,141(10):1014-1018.
[7]Tartter PI,Quintero S,Barron DM.Perioperative blood transfusion associated with infectious complications after colorectal cancer operations[J].Am J Surg,1986,152(5):479-482.
[8]刘景汉,欧阳锡林.去白细胞输血基础和临床应用研究进展[J].中国输血杂志,2001,14(4):252-255.
[9]Klos M,Korsak J.Immunomodulatory effect of blood components transfusions[J].Pol Merkur Lekarski,2002,13(77):413-416.
[10]Osman HK,Peiris JS,Taylor CE,et al."Cy tomegalovirus disease"in renal allograft recipients:is human herpesvirus7 a co-factor for disease progression?[J].J Med Virol,1996,48(4):295-301.
[11]Nielsen HJ,Reimert CM,Dybkjaer E,et al.Bioactive substance accumulation and septic complications in a burn trauma patient:effect of perioperative blood transfusion?[J].Burns,1997,23(1):59-63.
[12]刘正敏,高新谱,韩雪莹.不同储存时间后过滤白细胞对浓缩红细胞临床疗效的影响[J].中国输血杂志,2003,16(3):182-183.
[13]符晓阳,袁记,杨金华.胃肠道肿瘤患者围手术期输血与术后感染的关系[J].河南外科学杂志,2005,11(1):45.
[14]Lu JC,Grayson AD,Jha P,et al.Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery[J].Eur J Cardiothorac Surg,2003,23(6):943-949.
[15]Grossi EA,Culliford AT,Krieger KH,et al.A survey of 77major infectious complications of median sternotomy:a review of 7,949 consecutive operative procedures[J].Ann Thorac Surg,1985,40(3):214-223.
[16]周晔,刘冰,王建华,等.心脏外科重症监护病房患者医院感染鲍氏不动杆菌及耐药性分析[J].中华医院感染学杂志,2010,20(5):725-726.
[17]Moskowitz DM,Klein JJ,Shander A,et al.Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center[J].Ann Thorac Surg,2004,77(2):626-634.
[18]Purkayastha S,Athanasiou T,Malinovski V,et al.Does clopidogrel affect outcome after coronary artery bypass grafting?A meta-analysis[J].Heart,2006,92(4):531-532.
[19]Eisen A,Giugliano RP.Antiplatelet and anticoagulation treatment in patients with non ST-segment elevation acute coronary syndrome:comparison of the updated North American and European guidelines[J].Cardiol Rev,2015.[Epub ahead of print]
[20]Barbieri L,Pergolini P,Verdoia M,et al.Platelet reactivity in patients with impaired renal function receiving dual antiplatelet therapy with clopidogrel or ticagrelor[J].Vascul Pharmacol,2015,11(1):31-36.
[21]Ratliff TM,Hodge AB,Preston TJ,et al.Bloodless pediatric cardiopulmonary bypass for a 3.2-kg patient whose parents are of Jehovah′s Witness faith[J].J Extra Corpor Technol,2014,46(2):173-176.
[22]Durandy Y.Perfusionist strategies for blood conservation in pediatric cardiac surgery[J].World J Cardiol,2010,2(2):27-33.
[23]Corwin HL,Gettinger A,Fabian TC,et al.Efficacy and safety of epoetin alfa in critically ill patients[J].N Engl J Med,2007,357(10):965-976.
[24]Schved JF.Preoperative autologous blood donation:a therapy that needs to be scientifically evaluated[J].Transfus Clin Biol,2005,12(5):365-369.
[25]Mondal NK,Sorensen EN,Pham SM,et al.Systemic inflammatory response syndrome in end-stage heart failure patients following continuous-flow left ventricular assist device implantation:differences in plasma redox status and leukocyte activation[J].Artif Organs,2015,22(2):89-91.
[26]Chryssos A,Stroup SJ,Pifer MM,et al.Management of heparin-resistant patients with benefits Maximizing biocompatibility in cardiopulmonary bypass:combining ATrynR recombinant antithrombinⅢand Carmeda R heparinbonded perfusion circuits:a case series[J].J Extra Corpor Technol,2015,47(1):44-47.
[27]Aldea GS,Doursounian M,O′Gara P,et al.Heparin-bonded circuits with a reduced anticoagulation protocol in primary CABG:a prospective,randomized study[J].Ann Thorac Surg,1996,62(2):410-417.
[28]Gunaydin S,Farsak B,Mccusker K,et al.Clinical and biomaterial evaluation of hyaluronan-based heparin-bonded extracorporeal circuits with reduced versus full systemic anticoagulation in reoperation for coronary revascularization[J].J Cardiovasc Med(Hagerstown),2009,10(2):135-142.
[29]Ferraris VA,Ferraris SP,Saha SP,et al.Perioperative blood transfusion and blood conservation in cardiac surgery:the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline[J].Ann Thorac Surg,2007,83(5 Suppl):S27-S86.
[30]Balachandran S,Cross MH,Karthikeyan S,et al.Retrograde autologous priming of the cardiopulmonary bypass circuit reduces blood transfusion after coronary artery surgery[J].Ann Thorac Surg,2002,73(6):1912-1918.
[31]Ranucci M,Biagioli B,Scolletta S,et al.Lowest hematocrit on cardiopulmonary bypass impairs the outcome in coronary surgery:an Italian multicenter study from the National Cardioanesthesia Database[J].Tex Heart Inst J,2006,33(3):300-305.
[32]Habib RH,Zacharias A,Schwann TA,et al.Adverse effects of low hematocrit during cardiopulmonary bypass in the adult:should current practice be changed?[J].J Thorac Cardiovasc Surg,2003,125(6):1438-1450.
[33]Fergusson DA,Hebert PC,Mazer CD,et al.A comparison of aprotinin and lysine analogues in high-risk cardiac surgery[J].N Engl J Med,2008,358(22):2319-2331.
[34]Myles PS,Thompson G,Fedorow C,et al.Evaluation of differences in patient and physician perception of benefit and risks of aspirin and antifibrinolytic therapy in cardiac surgery[J].Anaesth Intensive Care,2014,42(5):592-598.
[35]Vander S T,Kaur S,Lancey R A,et al.Reduction of bleeding after heart operations through the prophylactic use of epsilon-aminocaproic acid[J].J Thorac Cardiovasc Surg,1996,112(4):1098-1107.
[36]Huang F,Wu Y,Yin Z,et al.A systematic review and metaanalysis of the use of antifibrinolytic agents in total hip arthroplasty[J].Hip Int,2015,25(6):502-509.
[37]Mongan PD,Brown RS,Thwaites BK.Tranexamic acid and aprotinin reduce postoperative bleeding and transfusions during primary coronary revascularization[J].Anesth Analg,1998,87(2):258-265.
[38]Eaton MP.Antifibrinolytic therapy in surgery for congenital heart disease[J].Anesth Analg,2008,106(4):1087-1100.
[39]Ichikawa J,Kodaka M,Kitahara T,et al.The use of thromboelastometry and tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery under cardiopulmonary bypass[J].Masui,2015,64(2):131-138.
[40]Koscielny J,von Tempelhoff GF,Ziemer S,et al.A practical concept for preoperative management of patients with impaired primary hemostasis[J].Clin Appl Thromb Hemost,2004,10(2):155-166.
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