摘要目的 制订肿瘤患者手术备血策略(SBOS),探讨肿瘤患者手术备血、用血的影响因素.方法 回顾性分析2002年10月至2012年5月中国医学科学院肿瘤医院手术备血患者的22 643人次备血申请资料和7430人次手术用血资料,并对入选资料的患者信息和检验结果进行分析.结果 手术输血率为32.81％ (7430/22 643).根据患者手术部位和手术治疗备血、输血数据,建立肿瘤患者SBOS:用血百分比＜30％的手术归入血型定型和抗体筛选,不用备血;其余类型手术采用交叉配血,备血量主要取决外科患者具体情况.多因素Logistic回归分析显示肿瘤患者的性别、血红蛋白、红细胞压积、血小板、总蛋白、白蛋白对手术是否输注红细胞有影响(OR=0.797、9.614、1.949、0.437、0.444、2.038,均P＜0.05);肿瘤患者的性别、血红蛋白、红细胞压积、活化部分凝血酶时间、凝血酶原时间、白蛋白、总蛋白对手术是否输注血浆有影响(OR=0.851、1.367、1.801、1.652、2.922、2.224、1.362,均P＜0.05).结论 肿瘤患者手术备血,应充分考虑患者的血常规检查结果、凝血功能、蛋白水平的影响,合理进行备血申请和输血,保证用血科学、安全.

abstractsObjective To design a blood ordering schedule and explore the influencing factors of blood utilizing and ordering for tumor surgical patients.Methods For a total of 58 306 tumor surgical patients,22 643 applications of blood ordering and 7430 person-times of blood utilization from October 2002 to May 2012 were retrospectively analyzed at Cancer Hospital of Chinese Academy of Medical Sciences.Their clinical profiles and test results were analyzed.Results The operative transfusion rate was 32.81％.According to the operation position and the blood transfusion and preparation data,the surgical blood ordering schedule of tumor patients was established.Patient gender,hemoglobin,hematocrit,platelet,total protein and albumin level test results had significant effect on the transfusion of red blood cells (OR =0.797,9.614,1.949,0.437,0.444,2.038,all P ＜ 0.05).Patient gender,hemoglobin,hematocrit,activated partial thromboplastin time,prothrombin time,albumin and total protein level test results had significant effect on the transfusion of plasma (OR =0.851,1.367,1.801,1.652,2.922,2.224,1.362,all P ＜ 0.05).Conclusion For surgical tumor patients,blood ordering should be based upon the test results of routine blood,blood coagulation and protein level test results to ensure that blood transfusion is both rational and safe.