刘 宇，石 云，高 妍，宋恒昌，徐 殊，王 强，吴海波，王辉山



非体外循环冠状动脉旁路移植术围术期输血的术前预测

刘 宇，石 云，高 妍，宋恒昌，徐 殊，王 强，吴海波，王辉山

［摘要］：目的 探讨非体外循环冠状动脉旁路移植术(OPCAB)围术期输血的术前预测指标。方法 回顾分析了120例行OPCAB患者的临床资料,通过受试者工作曲线(ROC)分析红细胞比容(Hct)体重乘积预测围术期输血的最佳临界值及预测围术期输血发生的灵敏度和特异度。结果 120例病例对照研究的患者术后输血15例,发病率为12.5%,ROC曲线下面积0.836,根据ROC曲线选定22.559为最佳临界值,预测围术期输血的灵敏度为47.38%,特异度95.88%。结论 Hct体重乘积对OPCAB围术期输血有较强的预测意义,Hct体重乘积＞22.559的患者OPCAB围术期输血发生率低。

［关键词］：非体外循环冠状动脉旁路移植；围术期输血；冠心病

Preoperative prediction of perioperative transfusion in off-pump coronary artery bypass graft

Liu Yu,Shi Yun,Gao Yan,Song Heng-cheng,Xu Shu,Wang Qiang,Wu Hai-bo,Wang Hui-shan
Department of Cardiovascular Surgery,the general hospital of Shenyang military command,Liaoning Shenyang 110016,China
Corresponding author:Wang Hui-shan,Email:huishanwang@ hotmail.com

［Abstract］：Objective To identifypreoperativeprediction index of perioperative transfusion in off-pump coronary artery bypass graft.Methods Clinical data was retrospectively collected and analyzed from patients who underwent off-pump coronary artery bypass graft(OPCAB) between August 2014 and December 2014.Receiver operating characteristic curve(ROC) was used to estimate optimal operating point(OOP),sensitivity and specifility for predicting preoperative transfusion.Results The morbidity of perioperative transfusion in retrospective clinical data was 12.5%.Area under the curve of ROC was 0.836.Meanwhile,22.559 was selected as OOP based on ROC.The sensitivity and specifility of predicting preoperative transfusion were 47.38%and 95.88%respectively.Conclusion

Product of hct and weight on the preoperativeprediction of perioperative transfusion in OPCAB is powerful.The morbidity of perioperative transfusion in OPCABis lower when Product of hct and weight is more than 22.559.

［Key words］： Off-pump coronary artery bypass graft；Perioperative transfusion；Coronary heart disease

冠状动脉旁路移植术(coronary artery bypass grafting,CABG)是治疗冠状动脉粥样硬化性心脏病多支血管病变、左主干病变的重要治疗方法。其中,非体外循环冠状动脉旁路移植术((off-pump coronary artery bypass grafting,OPCAB)是一种微创的CABG,可以显著降低CABG围术期的输血风险[1],对于节约用血、减少围术期异体输血具有重要作用。既往的研究表明[2],女性、低体重患者、术前贫血的患者CABG术后输血的风险较大,结合上述三种危险因素的特点,笔者回顾性分析沈阳军区总医院心血管外科2014年8月至2014年12月行OPCAB手术的患者120例,探讨OPCAB围术期输血术前预测的价值,报告如下。

1 资料与方法

1.1 临床资料 回顾性分析2014年8月至2014 年12月期间沈阳军区总医院心血管外科单一手术医师连续120例成人择期行OPCAB的患者,男97例,女23例,年龄(60.43±9.57)岁,体重(71.61± 11.62)kg,术前红细胞比容(Hct)(0.39±0.05)。……