摘要
目的分析血栓弹力图指导的凝血管理对儿童大脑半球切除术异体成分血输注需求的影响。方法回顾性收集2011年1月1日至2023年10月31日首都医科大学宣武医院38例行大脑半球切除术患儿的临床资料,根据术中是否应用血栓弹力图指导凝血管理分为研究组(n=17)和对照组(n=21)。比较两组患儿基本临床信息及手术情况。主要研究终点为患儿异体成分血输注率,包括血浆输注率、红细胞输注率及血小板输注率。次要研究终点为术中出血量、术后住院期间癫痫发作率、术后血栓栓塞事件发生率及住院时间等。结果研究组男13例,女4例,年龄(5.7±3.3)岁;对照组男16例,女5例,年龄(7.4±3.4)岁。研究组患儿手术时间、麻醉时间及预防性氨甲环酸使用率分别为(424.5±98.5)min、(542.8±106.9)min及94.1%(16/17),均高于对照组的(353.1±85.3)min、(445.3±87.9)min及47.6%(10/21)(均P<0.05)。研究组术中及围手术期异体血浆输注率分别为52.9%(9/17)及64.7%(11/17),均低于对照组的90.5%(19/21)及95.2%(20/21)(均P<0.05)。研究组纤维蛋白原输注率为58.8%(10/17),高于对照组的4.8%(1/21)(P=0.001)。两组患儿术中及围手术期异体红细胞输注率差异均无统计学意义(均P>0.05)。两组患儿均未输注血小板。两组患儿术中出血量、术后住院期间癫痫发作率以及住院时间差异均无统计学意义(均P>0.05)。两组患儿术后均未发生血栓栓塞事件。结论血栓弹力图指导的凝血管理可降低儿童大脑半球切除术的异体血浆输注需求,未降低异体红细胞输注需求。
Objective To evaluate the influence of thromboelastography-guided hemostatic algorithm on allogeneic transfusion requirements during pediatric hemispherectomy.Methods Clinical data of 38 children who underwent hemispherectomy from January 1,2011 to October 31,2023 at Xuanwu Hospital of Capital Medical University were retrospective collected.Patients were divided into study group(n=17)and control group(n=21)according to whether thromboelastography was employed to guide hemostatic algorithm.Demographic data and surgical data were recorded.The primary outcomes were allogeneic transfusion rates,including RBC transfusion rate,plasma transfusion rate,and platelets transfusion rate.The second outcomes were estimated blood loss,postoperative seizures during hospitalization,thromboembolic events,and length of hospital stay.Results There were 13 boys and 4 girls with mean age of(5.7±3.3)years old in study group,and 16 boys and 5 girls with mean age of(7.4±3.4)years old in control group.The surgery duration,anesthesia duration and the proportion of prophylactic administration of tranexamic acid in study group were(424.5±98.5)min,(542.8±106.9)min,and 94.1%(16/17),which were higher than(353.1±85.3)min,(445.3±87.9)min,and 47.6%(10/21)in control group(all P<0.05).The rates of intra-and perioperative allogeneic plasma transfusion in study group were 52.9%(9/17)and 64.7%(11/17)respectively,which were lower than 90.5%(19/21)and 95.2%(20/21)in control group(all P<0.05).The ratio of fibrinogen concentrates administration in study group was 58.8%(10/17),which was higher than that in control group[4.8%(1/21),P=0.001].There were no statistically differences in intra-and perioperative allogeneic RBC transfusion rates between the two groups(all P>0.05).No platelets were transfused in both groups.There were no statistically differences in estimated blood loss,postoperative seizures during hospitalization and the length of hospital stay between the two groups(all P>0.05).No postoperative thromboembolic events were observed.Conclusion
作者
冯华
王淳秀
刘清海
肖玮
王天龙
Feng Hua;Wang Chunxiu;Liu Qinghai;Xiao Wei;Wang Tianlong(Department of Anesthesiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Evidence-based Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2024年第23期2142-2147,共6页
National Medical Journal of China
基金
北京市属医院科研培育计划(PX2018075)
关键词
大脑半球切除术
血栓弹力图
麻醉
输血
Hemispherectomy
Thromboelastography
Anesthesia
Blood transfusion
