本文關(guān)鍵詞： 術(shù)中自體血回收 異體輸血 危險因素　出處：《遵義醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究分析骨科手術(shù)中行自體血回收(IBS)的患者術(shù)后輸注異體血的危險因素,為圍術(shù)期輸血提供有效依據(jù)。方法:選擇遵義醫(yī)學(xué)院附屬醫(yī)院2013年5月至2015年5月行骨科手術(shù)并應(yīng)用IBS的成年患者279例進(jìn)行回顧性數(shù)據(jù)采集。對行IBS的骨科患者術(shù)后需輸注異體血的影響因素進(jìn)行二分類Logistic回歸分析,依據(jù)預(yù)測數(shù)據(jù)集P繪制ROC曲線并求出最佳臨界值。預(yù)留38例行IBS的骨科患者的臨床資料代入回歸模型中,檢驗(yàn)回歸模型預(yù)測的準(zhǔn)確率。結(jié)果:所選取的279例病患中,術(shù)后輸注異體血的患者有83例(29.7%),平均輸注RBC的量為(2.48±1.39)U。單因素分析結(jié)果顯示:年齡、性別、ASA分級、術(shù)前血紅蛋白數(shù)值、手術(shù)時間、回收血量、出血量和術(shù)后切口引流量這8個變量具有顯著性差異(P0.05)。將無多重共線性的自變量納入二分類Logistic回歸方程,結(jié)果顯示:年齡(OR=0.415,P=0.006)和術(shù)前血紅蛋白數(shù)值(OR=0.532,P=0.022)為行IBS的骨科患者術(shù)后輸注異體血的保護(hù)因素。ASA分級(OR=2.393,P=0.035)和術(shù)后切口引流量(OR=4.279,P=0.000)為行IBS的骨科患者術(shù)后輸注異體血的危險因素。ROC曲線下面積為0.790,模型的預(yù)測準(zhǔn)確率為81.58%。結(jié)論:本研究的回歸模型對判斷行IBS的骨科患者術(shù)后是否需要輸注異體血有較高的準(zhǔn)確率。行IBS的骨科患者術(shù)后仍然有較高的異體血輸注率,因此不應(yīng)過分的依賴IBS,圍術(shù)期仍需從眾多影響因素中去考慮和完善血液保護(hù)措施,從而真正降低異體輸血的風(fēng)險。
[Abstract]:Objective: to study the risk factors of transfusion of allogeneic blood in patients undergoing orthopedic surgery with autogenous blood recovery (IBS). Methods: 279 adult patients who underwent orthopedic surgery and IBS from May 2013 to May 2015 in the affiliated Hospital of Zunyi Medical College were selected for retrospective data collection. Orthopaedic patients undergoing IBS were selected. The factors influencing the transfusion of allogeneic blood were analyzed by two classification Logistic regression analysis. According to the predicted data set P, the ROC curve was drawn and the optimal critical value was obtained. The clinical data of 38 orthopaedic patients who had been reserved for IBS were added to the regression model to test the prediction accuracy of the regression model. Results: among the 279 selected patients, There were 83 patients with allogeneic blood transfusion after operation. The average volume of RBC infusion was 2.48 鹵1.39U. The results of univariate analysis showed that age, sex, preoperative hemoglobin value, operation time, blood volume were recovered. There were significant differences between the eight variables of bleeding volume and incision drainage volume (P 0.05). The independent variables without multiple collinearity were included in the two-class Logistic regression equation. The results showed that the protective factors of postoperative transfusion of allogeneic blood in orthopaedic patients undergoing IBS were the age of ORA 0.415 / P0. 006) and preoperative hemoglobin value of 0.532P0. 022). ASA grade OR2. 393 P0. 035) and postoperative incision drainage volume were the risk factors of postoperative transfusion of allogeneic blood in orthopaedic patients undergoing IBS. (4. 279P0. 000) were the risk factors for postoperative transfusion of allogeneic blood in orthopedic patients undergoing IBS. The area under the curve is 0.790, and the prediction accuracy of the model is 81.58.Conclusion: the regression model of this study has a high accuracy in judging whether orthopaedic patients undergoing IBS need transfusion of allogeneic blood after operation. The orthopaedic patients undergoing IBS are still alive after operation. There is a high rate of allogeneic blood transfusion. Therefore, we should not rely too much on IBS. In order to reduce the risk of allogeneic blood transfusion, we should consider and improve the blood protection measures in perioperative period.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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