摘要目的:探讨自体血回输在外科手术输血治疗中的价格优势。方法:选择2019年1月至6月于空军军医大学第一、二附属医院和西安交通大学第一附属医院行外科手术时，接受输血治疗的185例患者为研究对象。患者年龄为(46.6±4.3)岁，男、女性患者分别为97和88例，接受肝移植、脾切除术和肝破裂修补术者分别为46、55和84例。根据患者的术中输血情况，将其分为自体血回输组( n＝60)，洗涤红细胞(WRBC)异体血输注组( n＝61)，去白细胞悬浮红细胞(LPRBC)异体血输注组( n＝64)。根据《陕西省城市公立医院医疗服务项目价格(2017年版)》和陕西省中心血站供应血液价格收费标准相关规定，计算3组患者的输血治疗费用。采用回顾性研究方法，收集所有患者的一般人口学资料和输血相关临床资料，并且分析3组患者的手术输血治疗费用。患者输血治疗费用与输血量之间的线性关系分析，采用直线回归分析。3组患者的输血治疗费用的总体比较，采用单因素方差分析；组间两两比较，采用LSD- t检验。3组患者年龄，性别和手术类型构成比分别比较，差异均无统计学意义( P>0.05)。本研究遵循的程序符合2013年修订版《世界医学协会赫尔辛基宣言》要求。 结果:①自体血回输组、WRBC异体血输注组和LPRBC异体血输注组患者的输血量分别为300~1 800、244~1 440和240~1 440 mL，治疗费用分别为1 325~1 430、629~3 659和609~3 539元，3组患者的输血量与治疗费用均呈良好的线性关系( r＝0.992、0.999、0.999， P<0.001)；当患者的WRBC和LPRBC异体血输注量分别超过514和531 mL时，其输血治疗费用超过自体血回输。② 3组患者中，接受600~720、720~960、960~1 200、1 200~1 440 mL输血量治疗者的输血治疗费用分别比较，差异均有统计学意义( F＝105.460、101.122、110.925、121.041， P<0.001)；自体血回输组的治疗费用分别为(1 356±87)元、(1 301±105)元、(1 387±132)元、(1 335±187)元，均分别低于LPRBC异体血输注组的(1 841±94)元、(2 447±138)元、(3 053±178)元、(3 669±234)元和WRBC异体血输注组的(1 781±103)元、(2 367±56)元、(2 953±217)元、(3 539±256)元，并且差异均有统计学意义(自体血回输组比LPRBC异体血输注组： t＝314.76、749.20、877.43、1 024.96， P<0.001；自体血回输组比WRBC异体血输注组： t＝278.39、693.48、849.37、976.26， P<0.001)。 结论:相较于异体血输注，自体血回输在外科手术输血治疗中具有一定价格优势。特别是输血量较大时，价格优势更明显。

abstractsObjective:To explore price advantage of autologous blood transfusion in intraoperative blood transfusion.Methods:From January to June 2019, a total of 185 patients who received blood transfusion during surgical operations in the First Affiliated Hospital of Air Force Military Medical University, the Second Affiliated Hospital of Air Force Military Medical University, or the First Affiliated Hospital of Xi′an Jiaotong University were selected as the study subjects. The patients were (46.6±4.3) years old. And there were 97 males and 88 females, and 46, 55 and 84 cases underwent liver transplantation, splenectomy and liver rupture repair, respectively. According to intraoperative blood transfusion, these patients were divided into autologous blood transfusion group ( n=60), washed red blood cells (WRBC) allogeneic transfusion group ( n=61), and leukocyte poor red blood cells (LPRBC) allogeneic transfusion group ( n=64). According to the relevant provisions of the Medical Service Project Price of Urban Public Hospitals in Shaanxi Province (2017 Edition) and the blood supply price and fee standard of Central Blood Stations in Shaanxi Province, the blood transfusion treatment fee of patients in 3 groups were calculated. A retrospective study was conducted to collect the general demographic data and transfusion related clinical data of all patients, and to analyze the fee of surgical transfusion treatment in the 3 groups. The linear relationship between fee and volume of blood transfusion was analyzed by linear regression. The overall comparison of blood transfusion treatment fees among the three groups was performed by one-way analysis of variance; LSD- t test was used for pairwise comparison between groups. There was no statistical significance in composition ratios of age, gender and type of surgery among the 3 groups ( P>0.05). The procedure followed in this study is in accordance with the Declaration of Helsinki of the World Medical Association revised in 2013. Results:① The blood transfusions volume in autologous blood transfusion group, WRBC allogeneic transfusion group and LPRBC allogeneic transfusion group were 300-1 800, 244-1 440 and 240-1 440 mL, respectively; and treatment fees were 1 325-1 430, 629-3 659 and 609-3 539 yuan, respectively. There was a good linear relationship between blood transfusion volume and treatment fees in the 3 groups ( r=0.992, 0.999, 0.999; P<0.001). When the volume of WRBC and LPRBC allogeneic transfusions exceeded 514 and 531 mL respectively, the fees of transfusion treatment exceeded that of autologous blood transfusion. ② In the 3 groups, the differences of blood transfusion treatment fees for patients receiving 600-720, 720-960, 960-1 200, 1 200-1 440 mL blood transfusion were statistically significant ( F=105.460, 101.122, 110.925, 121.041; P<0.001). The fees of blood transfusion treatment in autologous blood transfusion group were (1 356±87) yuan, (1 301±105) yuan, (1 387±132) yuan and (1 335±187) yuan respectively, which were lower than those of (1 841±94) yuan, (2 447±138) yuan, (3 053±178) yuan, (3 669±234) yuan in LPRBC allogeneic transfusion group and (1 781±103) yuan, (2 367±56) yuan, (2 953±217) yuan and (3 539±256) yuan in WRBC allogeneic transfusion group, and the differences were statistical significance (autologous blood transfusion group vs LPRBC allogeneic blood transfusion group: t=314.76, 749.20, 877.43, 1 024.96; P<0.001; autologous blood transfusion group vs WRBC allogeneic blood transfusion group: t=278.39, 693.48, 849.37, 976.26; P<0.001). Conclusions:Compared with allogeneic blood transfusion, autologous blood transfusion has a certain price advantage in surgical blood transfusion. And with the increase of transfusion volume, the price advantage of autologous blood transfusion became more obvious.