Liu Lin,Zhang Jianmin,Zhao Xin,et al.Effect of intraoperative autotransfusion on coagulation function during orthopedic spine surgery in preschool children[J].Journal of Clinical Pediatric Surgery,2019,18(07):579-582.[doi:10.3969/j.issn.1671-6353.2019.07.012]
术中回收式自体输血对接受脊柱矫形手术的学龄前儿童凝血功能的影响研究
- Title:
- Effect of intraoperative autotransfusion on coagulation function during orthopedic spine surgery in preschool children
- 分类号:
- R614;R681.5;R552
- 摘要:
- 目的 初步分析学龄前儿童脊柱侧弯矫形术中自体血液回输对其凝血功能的影响。方法 以首都医科大学附属北京儿童医院收治的50例接受脊柱侧弯矫形手术的患儿为研究对象，根据出血量占血容量（estimated blood volume，EBV）百分比大小分为3组，其中A组出血量均<20% EBV，B组出血量均在20%~30% EBV之间，C组出血量均>30% EBV，分别于术前、自体血回输前、自体血回输后3个时段行血栓弹力图（Thromboela-stogram，TEG）检查，观察不同组别患儿凝血功能的变化情况。结果 TEG各指标水平在输入自体血前后差异无统计学意义（P>0.05）；术前水平与回输前及回输后水平差异均存在统计学意义（P<0.05）；凝血功能的变化主要与出血量有关，与自体血回输量无关；R值、K值随出血量的增多而上升，α角、最大振幅（MA）值则随出血量的增加而减小。术前与术后相比，A组患儿TEG各项指标变化差异无统计学意义（P>0.05）；B组和C组患儿术后TEG指标中R值、K值与术前相比明显升高，α角、MA值则明显下降（P<0.05）。结论 出血量≤ 20% EBV的患儿行自体血回输后凝血功能无明显变化；而出血量>20% EBV时应警惕术后凝血功能降低的可能性，此时应根据相关检查结果适当补充凝血因子、血小板及纤维蛋白原等。
- Abstract:
- Objective To explore the effect of intraoperative autotransfusion on coagulation function in the scoliosis of preschoolers.Methods A total of 50 pediatrics patients undergoing scoliosis surgery were enrolled and divided into 3 groups according to the percentage of blooding volume and estimated blood volume(EBV):group A(<20%),group B(20-30%) and group C(>30%).Thromboela-stogram(TEG) was performed before operation,before and after autologous blood transfusion.Postoperative blood coagulation function was observed in each group.Results Significant differences existed in TEG indicators preoperative and pre-autologous transfusion(P<0.05).Similarly,significant differences also existed between preoperative TEG indicators and post-autologous transfusion(P<0.05).However,no difference was found in TEG indicators before and after blood transfusion.Amount of blood loss,but not autologous blood transfusions affected coagulation function.R and K values were prolonged with greater amount of blood loss while the other indicators decreased.No significant difference in TEG between preoperative and postoperative in group A.In groups B and C,R and K values significantly increased after transfusion while MA and α declined markedly(P<0.05).Conclusion There is no damage of coagulation function in patients with blood loss volume ≤ 20% after autologous blood transfusion.However,when blood loss is >20%,postoperative coagulation dysfunction should be considered.Coagulation factors,platelets and fibrinogen should be supplemented promptly according to the relevant examinations.
参考文献/References:
1 Chaoqun Y,Hailong Z,Shisheng H,et al.Efficacy and safety of using antifibrinolytic agents in spine surgery:a meta-analysis[J].PLoS ONE,2013,8(11).DOI:10.1371/journal.pone.0082063.
2 Tang JH,Lyu Y,Cheng LM,et al.Risk factors for the postoperative transfusion of allogeneic blood in orthopedics patients with intraoperative blood salvage[J].Medicine,2016,95(8).DOI:10.1097/MD.0000000000002866.
3 Zhou J.A review of the application of autologous blood transfusion[J].Brazilian Journal of Medical and Biological Research,2016,49(9).DOI:10.1590/1414-431X20165493.
4 Spain DA,Miller FB.Quality assessment of intraoperative blood salvage and[J].American Surgeon,1997,63(12):1059-1063.
5 Cataldi S,Bruder N,Dufour H,et al.Intraoperative autologous blood transfusion in intracranial surgery[J].Neurosurgery,1997,40(4):765-771.DOI:10.1097/00006123-199704000-00021.
6 任鹏程,安丽君,吕海港,等.双膝关节置换术中自体血回输对患者凝血功能的影响[J].临床麻醉学杂志,2011,27(6):613-613.DOI:10.1007/s10570-010-9464-0.Ren PC,An LJ,Lv HG,et al.Effect of autologous blood transfusion on coagulation function in patients undergoing double knee arthroplasty[J].Journal of Clinical Anesthesiology,2011,27(6):613-613.DOI:10.1007/s10570-010-9464-0.
7 李晗歌,张志永,黄宇光,等.少量出血患者使用术中回收式自体输血有效性的随机对照研究[J].协和医学杂志,2015,(1):9-13.DOI:10.3969/j.issn.1674-9081.2015.01.002.Li HG,Zhang ZY,Huang YG,et al.Effectiveness of intraoperative autotransfusion during mildly bleeding surgery:a randomized controlled trial[J].Medical Journal of Peking Union Medical College Hospital,2015,(1):9-13.DOI:10.3969/j.issn.1674-9081.2015.01.002.
8 Froessler B,Weber I,Hodyl NA,et al.Dynamic changes in clot formation determined using thromboelastometry after reinfusion of unwashed anticoagulated cell-salvaged whole blood in total hip arthroplasty[J].Blood Transfus,2015,13(3):448-454.DOI:10.2450/2015.0311-14.
相似文献/References:
[1]杨丽君 林茹 叶莉芬. 小儿先天性心脏病手术中残余机血洗涤回输对凝血功能的影响[J].临床小儿外科杂志,2012,11(06):409.
[J].Journal of Clinical Pediatric Surgery,2012,11(07):409.
[2]沈秋龙,陈亚军,彭春辉,等.肝脏硬度测量值预测胆道闭锁术后五年自体肝生存的价值研究[J].临床小儿外科杂志,2020,19(06):486.[doi:10.3969/j.issn.1671-6353.2020.06.005]
Shen Qiulong,Chen Yajun,Peng Chunhui,et al.Predicting five-year native liver survival after Kasai procedure of biliary atresia by liver stiffness measurement[J].Journal of Clinical Pediatric Surgery,2020,19(07):486.[doi:10.3969/j.issn.1671-6353.2020.06.005]
[3]隆琦,钭金法,陈菲,等.胆道闭锁Kasai术后自体肝生存良好患儿的营养状况调查[J].临床小儿外科杂志,2020,19(06):491.[doi:10.3969/j.issn.1671-6353.2020.06.006]
Long Qi,Tou Jinfa,Chen Fei,et al.Nutritional status of children with biliary atresia surviving well after Kasai surgery[J].Journal of Clinical Pediatric Surgery,2020,19(07):491.[doi:10.3969/j.issn.1671-6353.2020.06.006]
[4]孙鸣蔚,林茹.小儿先天性心脏病手术后出凝血管理的研究进展[J].临床小儿外科杂志,2021,20(06):550.[doi:10.12260/lcxewkzz.2021.06.009]
Sun Mingwei,Lin Ru.Research advances of postoperative coagulation management during pediatric cardiac surgery[J].Journal of Clinical Pediatric Surgery,2021,20(07):550.[doi:10.12260/lcxewkzz.2021.06.009]
备注/Memo
收稿日期:2019-3-10。
基金项目:首都临床特色应用研究与成果推广（编号：Z161100000516142）
通讯作者:张建敏,Email:zjm428@sina.com