Retrospective analysis of anesthesia management of massive transfusion patients undergoing retroperitoneal tumor resection
Objective:To evaluate the key points of anesthesia management and prognostic factors for massive transfusion patients undergoing retroperitoneal tumor resection.Methods:Retrospective analysis was performed on 85 massive transfusion patients with retroperitoneal tumor resection under general anesthesia from January 2016 to December 2021 in our hospital. Data on anesthesia management, blood loss, blood transfusion and biochemical examination were collected and prognostic factors were analyzed.Results:A total of 85 patients were included in this study, mean age (49.7±14.9) years, 4 patients ASA physical status Ⅰ, 41 patients ASA Ⅱ, 38 patients ASA Ⅲ and 2 patients ASA Ⅳ. Mean duration of operation was 8.1 h, mean duration of anaesthesia was 9.1 h, the amount of intraoperative bleeding was 3 500~25 800 ml, In 21 patients, the bleeding volume were greater than 10 000 ml. 57 patients were transferred to intensive care unit. 71 patients were treated with infusions of 25% albumin, 76 patients were treated with fibrinogen, 72 patients received prothrombin complex concentrate, and 14 patients required platelet transfusion intraoperatively. Preoperative artery blood gas analysis showed that 36 patients suffered from varied degrees of anemia, haemoglobin values were (110.3±18.9) g/L. Anaemia was present in 74 patients postoperatively, haemoglobin values was (87.7±21.4) g/L. 41 patients (48.2%) had hypoproteinemia preoperatively, 61 patients (71.8%) developed hypoproteinemia postoperatively, albumin values were (30.0±7.6) g/L,19 patients had albumin levels less than 25 g/L on the 1st day after surgery. Preoperative fibrinogen were in the normal range in 81 patients, the values were (402.0±141.2) g/L. The plasma fibrinogen concentration was (247.4±96.0) g/L g/L on postoperative 1st day and there were 21 patients with the value of plasma fibrinogen level less than 2 g/L. 17 patients had acute kidney injury and 5 patients were on dialysis postoperatively. 18 patients with lower limb venous thrombosis and 1 patient with acute pulmonary embolism,2 patients needed secondary hemostasis surgery, 2 patients died within 24 h and 5 patients died within 30 postoperative period. The postoperative hospitalization length was (49.1±25.7) days, which was positively correlated with age, anesthesia time, operation time, operation times, postoperative blood glucose and preoperative fibrinogen; postoperative mortality was positively correlated with blood loss, RBC infusion, preoperative and postoperative lactate, negatively correlated with postoperative hemoglobin, platelet, albumin, and fibrinogen values.Conclusion:Attention should be paid to the reasonable proportion and type of blood products in retroperitoneal tumor surgery, and ensuring the normal coagulation system and fibrinolytic system is a key factor to reduce mortality and complications.
万方数据
