RESUMO
【Objective】 To predict the risk factors of intraoperative blood transfusion by establishing a random forest algorithm prediction model, and to evaluate its prediction performance in clinical. 【Methods】 A total of 48 176 patients who underwent surgery from January 2014 to December 2017 in the First Medical Center of the Chinese People′s Liberation Army General Hospital were collected and divided into a blood transfusion group(n=5 035) and a non-transfusion group(n=43 141) according to whether blood was transfused or not during the operation, and the age, gender, weight, blood routine, coagulation test indicators, surgical grade, number of operations and anesthesia methods, and preoperative blood transfusion history between the two groups were compared and analyzed. All cases were randomly divided into training set(n=33 723) and the test set(n=14 453), using the sklearn function package in the computer programming language(Python V 3.9.0) to introduce the random forest algorithm, with 2 groups of different factors incorporated into the random forest algorithm to build the model, and the model was evaluated using the operating curve(ROC). 【Results】 1) There were statistically significant differences between the blood transfusion group and the non-transfusion group in terms of gender, age, blood routine, coagulation function, surgical grade, and preoperative blood transfusion history(P0.05); 3) In the established intraoperative blood model, the blood routine, coagulation function and general anesthesia had a great influence, with the cumulative importance > " 0.90" ; 4) The ROC analysis showed that the area under the ROC curve of the random forest model was 0.91 and 0.82 in the training set and the test set, which demonstrated a good predictive ability. 【Conclusion】 The intraoperative blood, using prediction model based on random forest method, can predict intraoperative blood use and blood transfusion risk factors.
RESUMO
【Objective】 To provide reference for formulating preoperative blood preparation plan for malignant osteosarcoma scientifically and rationally under the persistent COVID-19 epidemic by studying the high-risk influencing factors related to intraoperative blood transfusion in patients with primary malignant osteosarcoma. 【Methods】 The general data, preoperative blood routine and coagulation parameter, clinicopathological record and surgical data of 120 patients with primary malignant osteosarcoma in Beijing Jishuitan Hospital from January 2020 to January 2021 were retrospectively analyzed by univariate analysis, multivariate regression analysis and Pearson correlation analysis to determine the high risk factors for intraoperative blood transfusion in patients with primary malignant osteosarcoma. 【Results】 The incidence of intraoperative and postoperative blood transfusion of malignant osteosarcoma patients were 48.33% (58/120) and 62.50% (75/120), with the average blood transfusion units at (1.36±1.14) U and (2.93±2.26) U, respectively. The univariate analysis showed that such factors as sex, preoperative Hct (%), preoperative Plt (×109/L), location of lesion, Huvos classification, incision length (cm), reconstruction length(cm) and intraoperative blood loss (mL) were significantly different (P<0.05). Multivariate logistic regression analysis showed that sex, location of lesion, Huvos classification, incision length (cm), reconstruction length(cm) and intraoperative blood loss (mL) were significantly different (P<0.05). 【Conclusion】 For primary malignant osteosarcoma with a high rate of intraoperative blood transfusion, early intervention should be carried out according to the high-risk factors of intraoperative blood transfusion, and preoperative blood preparation plan should be accurately formulated to effectively reduce the rate and units of blood transfusion in patients under the premise of surgery safety.
RESUMO
【Objective】 To investigate the effects of tranexamic acid(TXA) on intraoperative blood transfusion(volume) and postoperative coagulation function in patients with partial hepatectomy for hepatic hydatid disease in high altitude area(altitude ≥2 500 m). 【Methods】 Forty-four patients [(39.09±14.70) years old, 19 males and 25 females] underwent elective partial hepatectomy for hydatid after general anesthesia from October 2018 to December 2019 in the Department of Hydatid of Qinghai Provincial People's Hospital, with ASA gradeⅠ~Ⅲ, Child Pugh grade A~B, and normal preoperative coagulation function. They were randomly divided into TXA injection group, who received intravenous injection of TXA 10 mg/(kg·person)(30 min before surgery), and control group, given a placebo needed the equal amounts of injected 0.9% sodium chloride(30 min before surgery). 3 mL of arterial blood was extracted from each patient before intravenous injection and at the end of operation for TEG detection. The intraoperative blood loss and transfusion volume as well as Plt, Hb and TEG parameters before and after surgery were compared between the two groups, and statistical analysis was performed with SPSS22.0 statistical software. 【Results】 The volume of intraoperative blood loss(mL) in TXA group and control group was 300(200, 1 000) vs 1 400(1 000, 2 100), respectively; the units of plasma transfusion(mL) 0(0, 0) vs 380(0, 575); the units of RBC suspension transfusion(mL) 0(0, 400) vs 1 200(800, 600). Preoperative TEG parameters of two groups were similar to each other(P>0.05). The postoperative R, K and Angle(°) of two groups was 8.32±2.24 vs 10.78±2.67, 2.80(2.10, 3.30) vs 3.70(3.20, 4.80) and 54.76±9.48 vs 43.70±9.02, respectively(P<0.05). 【Conclusion】 TXA can significantly improve coagulation functions, as well as effectively reduce intraoperative blood loss and intraoperative blood transfusion in patients with partial hepatic resection of hydatid hepatica in high altitude area.