评价腹膜后肿瘤切除术中大量输血患者的麻醉管理要点并分析其预后影响因素。

纳入2016年1 月至2021年12月北京大学国际医院在全身麻醉下实施腹膜后肿瘤切除术、24 h内输血超过20 U的85例患者，平均年龄（49.7±14.9）岁，其中ASA Ⅰ级4例、ASA Ⅱ级41例、ASA Ⅲ级38例、ASA Ⅳ级2例；手术时长平均8.1 h，麻醉时长平均9.1 h；总结麻醉管理情况，如出血及输血、围术期生化检查和患者的预后。

术中出血3 500~25 800 ml，其中21例（24.7%）出血量≥10 000 ml，术中输注红细胞（24.9±8.5）U、血浆（2 532.9±1 133.6）ml，14例术中输注血小板，平均为（2.0±2.5）U；71例术中补充白蛋白，平均为（83.8.0±83.2）g；76例补充纤维蛋白原，平均为（2.1±1.8）g；72例患者术中补充凝血酶原复合物，平均为（1 116.7±1 030.1）U。术前血气分析36例患者不同程度贫血，血红蛋白（Hb）为（110.3±18.9）g/L；术毕出室74例（87.1%）患者存在不同程度贫血，Hb为（87.7±21.4）g/L；术后第1 d 60例（70.6%）存在不同程度贫血，Hb为（95.0±26.3）g/L；术前41例（48.2%）患者存在低蛋白血症，术后61例（71.8%）出现低蛋白血症，术后第1 d白蛋白（30.0±7.6）g/L，其中＜25 g/L者19例（20%）；术前81例患者纤维蛋白原在正常范围（402.0±141.2）g/L，术后第1 d为（247.4±96.0）g/L其中小于2 g/L 21例（24.7%）。术后17例患者发生急性肾损伤，透析患者5例（5.9%）；下肢静脉血栓患者18例（21.2%），急性肺栓塞患者1例（1.18%）；术后需二次手术止血2例（2.4%）；24 h内死亡2例（2.4%），术后30 d内死亡7例（8.2%）。术后住院时长（49.1±25.7）d，与年龄、麻醉时间、手术时间、手术次数、术毕血糖和术前纤维蛋白原呈正相关；术后30 d死亡率与失血量、术中及24 h之内输注RBC量、术前和术毕乳酸值呈正相关，与术毕和术后1 d血红蛋白、术毕血小板、白蛋白、纤维蛋白原值呈负相关。

腹膜后肿瘤手术大量输血时，应注意血制品输注的合理比例，围术期维持凝血和纤溶系统功能正常是降低死亡率和并发症的关键要素。

To evaluate the key points of anesthesia management and prognostic factors for massive transfusion patients undergoing retroperitoneal tumor resection.

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.

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 1^st 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.

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.