摘要目的:分析食管贲门癌患者围术期输血高需求危险因素，为实施及时有效临床干预以减少输血量积累更多循证医学证据。方法:回顾性分析运城市中心医院2012年1月至2018年10月收治的食管贲门癌患者154例的临床资料，其中围术期红细胞输注<5 U共100例设为对照组，围术期红细胞输注≥5 U共54例设为观察组；分析导致高需求输血原因、可能影响因素及其对术后相关临床指标的影响。结果:观察组合并基础疾病比例、术前贫血比例及术中失血量分别为85.19%（46/54）、48.15%（26/54）、（1 127.92±350.70）mL，均显著多于对照组的37.00%（37/100）、21.00%（21/100）、（296.47±98.31）mL（χ 2=6.17、7.40， t=7.54， P<0.01， P=0.03， P<0.01）；观察组患者术后并发症发生率为62.96%（34/54），显著高于对照组的33.00%（33/100）（χ 2=9.16， P=0.00）；两组住院时间及重症监护病房住院时间差异均无统计学意义（均 P>0.05）；观察组患者输血后血小板计数（PLT）为（190.47±73.48）×10 12/L，均显著高于对照组的（159.00±65.17）×10 12/L、输血前的（234.31±92.07）×10 12/L（ t=4.26、5.33，均 P<0.01）；两组输血后凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）差异无统计学意义（ P>0.05）；观察组患者输血后国际标准化比率（INR）为（1.06±0.15），显著高于输血前的（0.94±0.12）（ t=2.78， P=0.03）；观察组患者输血后血清K +水平为（3.97±0.42）mmol/L，显著低于输血前的（4.21±0.37）mmol/L（ t=4.01， P<0.01）；两组输血后血清Ca 2+水平差异无统计学意义（ P>0.05）。 结论:术前合并基础疾病和贫血是导致食管贲门癌患者围术期高需求输血出现可能危险因素；高需求输血发生主要因术后出血造成，同时还可引起术后凝血功能、血清离子水平紊乱及术后并发症发生风险升高。

abstractsObjective:To analyze the risk factors of a high demand for perioperative blood transfusion in patients with esophageal and cardiac cancer and to accumulate more evidence-based medicine findings for timely and effective clinical intervention to reduce the volume of blood transfused.Methods:The clinical data of 154 patients with esophageal and cardiac cancer who received treatment from January 2012 to October 2018 in Yuncheng Central Hospital were retrospectively analyzed. Among them, 100 patients who received < 5 U blood transfusion were included in the control group, and 54 patients who received ≥ 5 U blood transfusion were included in the observation group. The causes of a high demand for blood transfusion, the possible influential factors, and their effects on related clinical indicators post-surgery were analyzed.Results:The proportion of patients with underlying diseases, the proportion of patients with anemia pre-surgery, and the amount of blood loss in the observation group were 85.19% (46/54), 48.15% (26/54) and (1 127.92 ± 350.70) mL respectively, which were significantly higher than those in the control group [37.00% (37/100), 21.00% (21/100) and (296.47 ± 98.31) mL, χ2 = 6.17, 7.40, t = 7.54, P < 0.01, P = 0.03, P < 0.01]. The incidence of postoperative complications in the observation group was significantly higher than that in the control group [62.96% (34/54) vs. 33.00% (33/100), χ2 = 9.16, P = 0.00]. There were no significant differences in hospital and intensive care unit lengths of stay between the two groups (both P > 0.05). Platelet count after blood transfusion in the observation group was (190.47 ± 73.48) × 10 12/L, which was significantly higher than (159.00 ± 65.17) × 10 12/L in the control group and (234.31 ± 92.07) × 10 12/L before blood transfusion in the observation group ( t = 4.26, 5.33, both P < 0.01). There were no significant differences in prothrombin time and activated partial thromboplastin time between the two groups (both P > 0.05). In the observation group, the international normalized ratio after blood transfusion was significantly higher than that before blood transfusion [(1.06 ± 0.15) vs. (0.94 ± 0.12), t = 2.78, P = 0.03]. In the observation group, serum K + level after blood transfusion was significantly lower than that before blood transfusion [(3.97 ± 0.42) mmol/L vs. (4.21 ± 0.37) mmol/L, t = 4.01, P < 0.01]. There was no significant difference in serum Ca 2+ level after blood transfusion between the two groups ( P > 0.05). Conclusion:Underlying diseases and anemia are the risk factors for a high demand for blood transfusion in patients with esophageal and cardiac cancer. A high demand for blood transfusion is mainly caused by postoperative bleeding. At the same time, blood transfusion can also increase the risks for abnormal coagulation function, abnormal serum ion levels, and complications post-surgery.