Preoperative factors as predictors of blood product transfusion requirements in orthotopic liver transplantation
Preoperative factors as predictors of blood product transfusion requirements in orthotopic liver transplantation
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DOI：
10.7182/prtr.21.3.7kq304t4680wgh06
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发表时间：
2011-09-01
影响因子：
0.8
通讯作者：
Malekhosseini, Ali
中科院分区：
文献类型：
--
作者：
Ghaffaripour, Sina;Mahmoudi, Hilda;Malekhosseini, Ali
肝移植是一项复杂的大量失血手术，术中输血可影响移植物存活的机会。验证可预测术中失血和输血的因素可提高麻醉管理的质量。目的：评估2002年至2008年成人背驮式原位肝移植患者血液和血液制品的使用情况，并评估血量和血液制品需求的相关因素。设计：回顾了2002年3月至2008年5月261例符合条件的成人原位肝移植受者的病历和麻醉记录。设拉子肝脏移植中心，伊朗唯一活跃的肝脏移植中心。主要结局指标-测量失血量和输血的潜在影响因素，包括性别、术前血红蛋白水平、国际标准化比值、初诊、血小板计数、肌酐水平、终末期肝病模型（MELD）评分、中心静脉压和总麻醉时间，并进行多变量分析。结果：平均失血量为54.2 (SD, 47.9) mL/kg，血制品输血量为25.3 (19.5)mL/kg，新鲜冷冻血浆输血量为2.6（3.3）单位，血小板输血量为1.7（3.1）单位。7例（2.7%）移植患者术中未输注红细胞，25例（9.6%）患者术中输注超过10个单位的红细胞。多变量分析显示，术前因素不能预测出血量或术中输血需求。2005年、2006年、2007年和2008年新鲜冷冻血浆和包装红细胞的输注量明显低于2003年至2004年
Context-Intraoperative transfusion can affect the chance of graft survival in liver transplantation, a complicated operation with massive blood loss. Verification of factors that are predictive of intraoperative blood loss and transfusion increases the quality of anesthesia management.Objective-To assess use of blood and blood products between 2002 and 2008 and to evaluate factors associated with blood loss and requirement for blood products in adult patients undergoing orthotopic liver transplantation via piggyback technique.Design-Medical charts and anesthesia records from 261 eligible adult recipients of an orthotopic liver transplant between March 2002 and May 2008 were reviewed.Setting-Shiraz Liver Transplantation Center, the only active liver transplantation center in Iran.Main Outcome Measures-Potential influencing factors in blood loss and transfusion, including sex, preoperative hemoglobin level, international normalized ratio, primary diagnosis, platelet count, creatinine level, Model for End-Stage Liver Disease (MELD) score, central venous pressure, and total anesthesia time, were measured and subjected to multivariable analysis.Results-Mean blood loss was 54.2 (SD, 47.9) mL/kg, the mean (SD) for amounts of blood products transfused was 25.3 (19.5) mL/kg for packed red blood cells, 2.6 (3.3) units for fresh frozen plasma, and 1.7 (3.1) units for platelets. Seven recipients (2.7%) underwent transplantation without intraoperative transfusion of red blood cells, whereas 25 patients (9.6%) received more than 10 units of red blood cells intraoperatively. Multivariable analysis showed that no preoperative factor was a predictor of blood loss or requirement for intraoperative transfusion. Transfusion of fresh frozen plasma and packed red blood cells was significantly lower in 2005, 2006, 2007, and 2008 than in 2003 to 2004 (P