Wang Chao,Zhang Jianmin,Wang Fang,et al.Effect of autologous blood transfusion on coagulation functions and prognoses of children after a removal of cerebral hematoma[J].Journal of Clinical Pediatric Surgery,2023,22(09):855-860.[doi:10.3760/cma.j.cn101785-202210051-011]
术中自体血回输对颅脑血肿清除术后患儿凝血功能及预后的影响
- Title:
- Effect of autologous blood transfusion on coagulation functions and prognoses of children after a removal of cerebral hematoma
- Keywords:
- Children; Cerebral Hematoma; Outcome; Coagulation; Autologous transfusion
- 摘要:
- 目的 探讨术中自体血回输对儿童颅脑血肿清除术后凝血功能及预后的影响。方法 本研究为回顾性研究,收集2016年2月至2022年4月在首都医科大学附属北京儿童医院行颅脑血肿清除术的132例患儿作为研究对象,根据术中使用血制品的种类分为A组(只使用自体血,n=16)、B组(只使用异体血,n=88)和C组(自体血、异体血均使用,n=28);比较三组患儿术后凝血功能及血常规、住院费用、住院时间、并发症、格拉斯哥结局量表评分。结果 A、B、C三组患儿术后活化部分凝血酶时间分别为33.0(29.0,38.6)s、33.2(30.3,37.9)s、33.8(30.7,44.3)s,术后凝血酶原时间分别为(13.5±1.2)s、(13.8±1.5)s、(14.2±2.2)s,术后国际标准化比值分别为(1.1±0.1)、(1.2±0.1)、(1.2±0.1),术后纤维蛋白原浓度分别为(2.4±0.8)g/L、(2.0±0.6)g/L、(2.0±0.9)g/L,差异均无统计学意义(P＞0.05);术后血红蛋白分别为(111.0±13.4)g/L、(112.4±20.4)g/L、(121.7±19.9)g/L,术后红细胞压积分别为(32.1±3.8)%、(32.2±5.6)%、(34.7±5.4)%,差异均无统计学意义(P＞0.05),术后血小板分别为[265.0(214.5,318.5)]×109、[217.0(165.0,267.5)]×109、[179.5(106.2,237.5)]×109,差异有统计学意义(P＜0.05),其中C组术后血小板的量较A组低,差异有统计学意义(P＜0.017);住院时间分别为9(5,14)d、8(5,11)d、12(5,21)d;住院费用分别为57 260(39 165,72 648)元、48 998(38 880,64 447)元、63 130(42181,83 260)元;感染人数分别为4例、12例、5例;脑疝人数分别为0例、2例、0例;癫痫人数分别为1例、8例、3例;血栓人数分别为0例、3例、0例;差异均无统计学意义(P＞0.05)。格拉斯哥结局量表评分:A组5分0例,4分16例,3分0例,2分0例,1分0例;B组5分1例,4分66例,3分9例,2分12例,1分1例;C组5分3例,4分15例,3分7例,2分3例,1分3例,差异有统计学意义(P＜0.05),A组格拉斯哥结局量表评分较C组低,差异有统计学意义(P＜0.017)。结论 儿童颅脑血肿清除术中使用自体血回输不影响凝血功能,且预后更佳。
- Abstract:
- Objective To explore the effect of autologous blood transfusion on coagulation functions and prognoses in children after a removal of cerebral hematoma.Methods For this retrospective study,132 children undergoing cerebral hematoma removal from February 2016 to April 2022 were selected as study subjects.They were assigned into three groups of A(n=16,autologous blood intra-operation),B(n=88,allogenic blood intra-operation)and C(n=28,both autologous and allogenic blood intra-operation).Coagulation functions and blood routines post-operation were compared among three groups.Hospitalization expense,length of hospitalization stay,postoperative complications and prognoses as valued by Glasgow outcome scale(GOS)were recorded.Results In three groups,partial thrombin activation time was[33.0(29.0,38.6)],[33.2(30.3,37.9)]and[33.8(30.7,44.3)]s;Prothrombin time(13.5±1.2),(13.8±1.5),(14.2±2.2)s;International standardized ratio(1.1±0.1),(1.2±0.1),(1.2±0.1);Postoperative fibrinogen concentration(2.4±0.8),(2.0±0.6),(2.0±0.9)g/L.There were no statistical differences(P>0.05).No postoperative complications were caused by blood transfusion.Postoperative hemoglobin was(111.0±13.4),(112.4±20.0),(121.7±19.9)g/L;Postoperative hematocrit(32.1±3.8)%,(32.2±5.6)%,(34.7±5.4)%.There were no statistical differences(P>0.05).Postoperative platelet of three groups was[265.0(214.5,318.5)]×109,[217.0(165.0,267.5)]×109,[179.5(106.2,237.5)]×109.There were no statistical differences(P<0.05).The count of platelet was significantly lower in group C than that in group A.There was statistical difference(P<0.017).Hospitalization time of three groups was[9(5,14)],[8(5,11)],[12(5,21)]day;Hospitalization expense[57 260(39 165,72 648)],[48 998(38 880,64 447)],[63 130(42 181,83 260)]yuan;Infection complications 4,12,5 cases;Complication of cerebral hernia 0,2,0 case;Complications of epilepsy 1,8,3 cases;Thrombotic complications 0,3,0 case.There were no statistical differences(P>0.05).GOS was 5(n=0),4(n=16),3(n=0),2(n=0),1(n=0)in group A,5(n=1),4(n=66),3(n=9),2(n=12),1(n=1)in group B and 5(n=3),4(n=15),3(n=7),2(n=3),1(n=3)in group C.The differences were statistically significant(P<0.05).GOS of group A was significantly better than that of group C and the difference was statistically significant(P<0.017).No significant changes existed in duration of hospitalization,expense of hospital or rate of complication among three groups(P>0.05).GCS,ASA and GOS grading of group A was significantly better than that(P<0.05).Conclusion Autologous blood transfusion does not impair blood coagulations significantly and the outcome is excellent in children after a removal of cerebral hematoma.
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备注/Memo
收稿日期:2022-10-24。
通讯作者:张建敏,Email:zhangjianmin@bch.com.cn