摘要
目的探讨青少年脊柱侧凸后路矫形术术后大量引流的危险因素。方法回顾性分析2010年11月至2015年10月南京大学医学院附属鼓楼医院11～18岁第一次进行后路矫形术的青少年脊柱侧凸患者病案资料共1461例。将患者以引流量与估计血容量比值分布的30％为临界点分为大量引流组和普通引流组，对两组患者的年龄、性别、体质指数（BMI）、美国麻醉医师协会（ASA）分级、脊柱侧凸诊断类型、术前Cobb角度、术前实验室检查，术中融合节段数、置钉数量、氨甲环酸的使用与否、是否使用胸廓成形术或截骨术、术中自体血回收数、手术时间、尿量、出血量、输血及输液量，术后住院时间、术后输血数、引流量、引流时间进行收集，采用单因素和多因素分析筛选大量引流的危险因素。结果所有患者术后平均引流量为（856．3±333．4）ml，大量引流组共有479例患者，占32．8％。多因素分析发现青少年脊柱侧凸后路矫形术术后大量引流的危险因素有：BMI〈17．63kg／m2，比值比（OR）=2．90，术前血小板计数〈190×10^9／L（OR=1．67），术前Cobb角≥55°（OR=1．66），术中融合节段数≥11个（OR=2．33），置钉数量≥15个（OR=1．73），使用截骨（OR=1．54），术中输晶体〉／35．63ml／kg（OR=t．40），术中输胶体〉／28．92ml／kg（OR=1．82），术中输血制品≥19．55ml／kg（OR=1．72）；而使用氨甲环酸则为保护因素（OR=0．26）。结论BMI〈17．63kg／m2、术前血小板计数〈190×10^9／L、术前Cobb角≥55°、术中融合节段数≥11个、置钉数量≥15个、使用截骨、术中输晶体〉135．63ml／kg、术中输胶体／〉28．92mt／kg、术中输血制品≥19．55ml／kg增加了青少年脊柱侧凸后路矫形术术后大量引流发生的风险，而使用氨甲环酸则降低了大量引流发生的风险。
Objective To identify risk factors that influence the massive drainage after posterior spinal orthopaedic surgery for adolescent scoliosis. Methods A total of 1 461 patients from 11 to 18 years old diagnosed with adolescent scoliosis who underwent first posterior spinal orthopaedic surgery in affiliated Drum Tower Hospital, Medical School of Nanjing University between November 2010 and October 2015 were retrospectively reviewed. Patients were categorized on the basis of massive or normal drainage, with the boundary 30th percentile of drainage/estimated blood volume. Preoperative factors including age, gender, body mass index （BMI）, ASA physical status, diagnostic type of scoliosis, main Cobb angle, laboratory tests, intraoperative factors including the number of fusion level and screws, tranexamic acid used or not, use of osteotomy and thoracoplasty, use of cell salvage technology, duration of operation, the volume of urine output, blood loss, fluid therapy and transfusion, postoperative factors including the length of hospital stay, number of transfusion, the volume of drainage, time of drain were collected. Univariate and multivariate analyses were used to determine risk factors which were independently associated with massive drainage. Results The average drainage was （ 856. 3 ± 333.4 ） ml. 479 （ 32. 8% ） patients had massive drainage （drainage ≥ 30% of drainage/estimated blood volume ）. Multivariate analysis identified risk factors of massive drainage： BMI 〈 17.63 kg/m2 ,odds ratio（OR） =2. 90, preoperative platelet count 〈 190 × 10^9/L （ OR = 1.67 ） , preoperative main Cobb angle ≥ 55 degrees （ OR = 1.66 ） , number of fusion levels ~ 11 （ OR = 2. 33）, number of screws ≥ 15 （ OR = 1. 73 ）, use of osteotomy （ OR = 1.54 ）, intraoperative volume of crystalloids≥35.63 ml/kg（ OR = 1.40）, intraoperative volume of colloids ≥28.92 ml/kg（ OR = 1.82）, intraoperative volume of transfusion ≥19.55 ml/kg （ OR = 1.72 ）, while the use of tranexamic acid �
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第44期3460-3465,共6页
National Medical Journal of China
