ABSTRACT
Objective: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.
ABSTRACT
Objective:To investigate the clinical value of baseline thromboelastogram as a predictor of early neurological deterioration in patients with acute ischemic stroke.Methods:The clinical data of 219 patients with acute ischemic stroke with onset time < 24 hours and National Institute Health of Stroke Scale (NIHSS) score < 16 points who received treatment in Yuncheng Central Hospital, China between January 2015 and January 2019 were retrospectively analyzed. These patients were divided into groups A (with early neurological deterioration, n = 68) and B (without early neurological deterioration, n = 151). Baseline data and thromboelastogram indices were compared between the two groups. Logistic regression was used to analyze the risk factors of early neurological deterioration in patients with acute ischemic stroke. Results:The proportion of male patients and the proportion of smokers in the group A were 58.82% and 20.59%, respectively, which were significantly lower than those in the group B (80.79%, 38.41%, χ2 = 11.40, 4.45, both P < 0.05). The proportion of patients with acute ischemic stroke complicated by diabetes mellitus, baseline National Institute Health of Stroke Scale score and serum high-sensitivity C-reactive protein level in the group A were 41.18%, (5.23 ± 1.90) points and (4.62 ± 0.72) mg/L, respectively, which were significantly higher than those in the group B [19.21%, (2.40 ± 1.35) points, (1.70 ± 0.49) mg/L, χ2 = 5.89, t = 2.26, 3.27, all P < 0.05)]. Coagulation reaction time and clotting time in the group A were (4.10 ± 1.08) minutes and (1.33 ± 0.30) minutes, respectively, which were significantly shorter than those in the group B [(4.41 ± 1.35) minutes, (1.56 ± 0.42) minutes, t = -3.72, -3.30, both P < 0.05). The proportion of patients with shortened coagulation reaction time and the proportion of patients with shortened clotting time in the group A were 82.35% and 22.06%, respectively, which were significantly higher than those in the group B (58.28%, 7.95%, χ2 = 5.86, 4.55, both P < 0.05). Logistic regression model analysis showed that shortening of coagulation reaction time is an independent risk factor of early neurological deterioration ( OR = 1.82, P < 0.05). Diabetes mellitus, baseline National Institute Health of Stroke Scale score and serum high-sensitivity C-reactive protein level were also associated with the occurrence of early neurological deterioration in acute ischemic stroke ( OR = 2.95, 1.38, 1.61, all P < 0.05). Conclusion:Shortening of coagulation reaction time can be used as a predictor of early neurological deterioration in mild and moderate acute ischemic stroke. Clinicians can evaluate the course of the disease and give targeted interventions according to early neurological deterioration, so as to further improve the clinical prognosis.