不同年龄儿童脊柱侧弯手术中血液保护的研究

目的 比较术中回收式自体输血(intraoperative autotransfusion,IAT)技术在不同年龄儿童脊柱侧弯手术中的应用效果.方法 2015年8月至2016年3月在北京儿童医院行脊柱侧弯后路矫形内固定术的患儿96例,按年龄分为C组(≤6岁)31例,T组(＞6～12岁)41例,A组(＞12～＜ 18岁)24例.术中均采用回收式自体输血方法行血液保护.记录患儿苏醒时间,术前、术后T1(1～2 d)、T2(3～5 d)及T3(6～7 d)的Hb、红细胞比容(HCT),术中、术后是否使用异体输血,住院时间及麻醉并发症发生情况.结果 T组及A组的手术时间长于C组,同时两组的出血量、自体血回收量、晶体液及胶体液用量也多于C组;A组患儿术中使用悬浮红细胞及新鲜冰冻血浆的比例高于另两组;A组患儿苏醒时间长于C组;C组与T组T1、T2的Hb及HCT均有所下降,术后1周恢复至术前水平;A组患儿术后3个时间点的Hb及HCT均低于术前水平;3组患儿住院时间的差异无统计学意义;3组均未发生麻醉相关并发症.结论 年长患儿行脊柱侧弯后路矫形内固定术的手术时间长、出血多、术后Hb及HCT恢复慢,在应用自体血回收技术的同时使用异体输血更为必要.

Blood conservation technique used in children with scoliosis of different age

Objective To compare the effects of intraoperative autotransfusion (IAT) technique used in children with scoliosis of different age.Methods A total of 96 children undergoing posterior fixation from August 2015 to March 2016 were divided into group C(≤6 years old,31 cases),group T(＞ 6-12 years old,41 cases) and group A(＞ 12-18 years old,24 cases).All of the groups used IAT technique.The recovering time,Hb and HCT of preoperation and postoperation (T l:1-2d,T2:3-5d,T3:6-7d),intraoperative and postoperative homologous blood transfusion,duration of hospital stay and complications were recorded.Results Operation time of group T and A was longer than group C.Volume of of bleeding,autotransfusion and liquid infusion was more than group C.Percentage of transfusion of group A was higher than the other two groups.Recovery time of group A was longer than group C.Hb and HCT on T1 and T2 of both group C and T declined and returned to normal on T3.Hb and HCT of all the three postoperative points of group A declined.There was no difference around the three groups on duration of hospital stay.No complication of anesthesia happened during this trial.Conclusion Longer duration of operation and more bleeding occured in older children undergoing posterior fixation can be observed.They recover more slowly on Hb and HCT when compared to children with younger age and shorter disease duration.Blood transfusion is more necessary with the application of IAT for this group of patients when compared to younger children.