【摘要】 目的 观察采用围术期输血指征评分(POTTS)指导围术期贫血患者输注红细胞对患者成分输血情况及凝血功能的影响。方法 将746例围术期贫血(血红蛋白60～100 g/L)患者随机分为试验组360例和对照组386例。采用POTTS评估试验组患者围术期是否需要输注异体红细胞，参照《临床输血技术规范》评估对照组患者围术期是否需要输注异体红细胞。观察两组患者术中失血量、术中回收式自体输血的患者比例及其输注总量、术中和术后输注异体红细胞的患者比例及其输注量、术中和术后输注凝血成分的患者比例及各类凝血成分输注量，手术前后和出院当日的血红蛋白水平、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT),以及切口愈合情况、住院时间。结果 试验组输注异体红细胞的患者比例及其输血量、输注凝血成分的患者比例及输注血浆的患者比例低于或少于对照组(均P<0.05)。试验组PT、APTT较对照组延长，两组患者PT、APTT均有随时间延长而变化的趋势(均P<0.05);两组患者FIB、TT差异均无统计学意义(均P>0.05)。两组患者切口愈合情况、住院时间差异均无统计学意义(均P>0.05)。结论 采用POTTS指导围术期贫血患者输注红细胞，能减少异体红细胞的使用，同时不影响患者的凝血功能及术后康复。更多还原

【Abstract】 Objective To observe the effect of red blood cell transfusion guided by perioperative transfusion trigger score(POTTS) on blood component transfusion and coagulation function in patients with perioperative anemia. Methods A total of 746 patients with perioperative anemia(hemoglobin 60-100 g/L) were randomized to experimental group(n=360) or control group(n=386). In the experimental group, patients′ demands for perioperative allogeneic red blood cell transfusion were evaluated using POTTS, and in the control group, patients′ demands for perioperative allogeneic red blood cell transfusion were evaluated referring to Technical Specifications for Clinical Blood Transfusion. Multiple indices of patients in the two groups were observed, including intraoperative blood loss, the proportion of patients receiving intraoperative autologous blood salvage and their total infusion volume, the proportions of patients undergoing intra-and postoperative allogeneic red blood cell transfusion and their infusion volumes, the proportion of patients who underwent intra-and postoperative coagulation components transfusion and the type and volume of coagulation components infused, hemoglobin levels, prothrombin time(PT), activated partial thromboplastin time(APTT), fibrinogen(FIB) and thrombin time(TT) preoperatively, postoperatively and on the day of discharge, as well as the condition of wound healing and the length of hospital stay. Results The experimental group exhibited declines in the proportion of patients transfused with allogeneic red blood cell and their transfusion volume, a lower proportion of patients who underwent coagulation components transfusion and a lower volume of plasma transfused as compared with the control group(all P<0.05). PT and APTT were prolonged in the experimental group than in the control group, and PT and APTT in both groups tended to change over time(all P<0.05); moreover, no statistically significant difference was found in FIB or TT between the two groups(all P>0.05). There were no statistically significant differences between the two groups in the condition of wound healing or the length of hospital stay(all P>0.05). Conclusion For perioperative patients with anemia, red blood cell transfusion guided by POTTS can diminish the usage of allogeneic red blood cell, and simultaneously, has no effects on patients′ coagulation function and postoperative recovery.更多还原