Schramm B, Leslie K, Myles P S, Hogan C J
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria.
Anaesth Intensive Care. 2001 Aug;29(4):388-92. doi: 10.1177/0310057X0102900410.
Unselected preoperative coagulation testing is known to have low positive yield. However, no study has specifically evaluated neurosurgical patients. A retrospective study of 1211 patients having neurosurgery over a one-year period was therefore conducted. Preoperative test results (activated partial thromboplastin time [aPTT], prothrombin time [PT] and platelet count) and historical factors indicating a potential bleeding tendency were recorded. Abnormality was defined as a test result outside the normal range for our laboratory. Seventeen per cent of all test results were abnormal. However, if abnormality was redefined as a test result indicating potential bleeding tendency (low platelet count, prolonged aPTT and/or PT), only 7.2% of results were abnormal. Many patients had factors on history indicating a potential bleeding tendency, but only a prolonged aPTT, cranial surgery and the use of anti-hypertensive and anaesthetic drugs preoperatively predicted postoperative bleeding. Prolonged aPTT was predictable on history in most patients. We conclude that routine screening of all preoperative neurosurgical patients in our hospital is unnecessary.
已知未经过筛选的术前凝血功能检测阳性率较低。然而，尚无研究专门评估神经外科患者。因此，我们对1211例在一年期间接受神经外科手术的患者进行了一项回顾性研究。记录术前检测结果（活化部分凝血活酶时间[aPTT]、凝血酶原时间[PT]和血小板计数）以及表明潜在出血倾向的既往因素。异常定义为超出我们实验室正常范围的检测结果。所有检测结果中有17%异常。然而，如果将异常重新定义为表明潜在出血倾向的检测结果（血小板计数低、aPTT延长和/或PT延长），则只有7.2%的结果异常。许多患者有既往因素表明潜在出血倾向，但只有aPTT延长、颅脑手术以及术前使用抗高血压药和麻醉药可预测术后出血。在大多数患者中，根据病史可预测aPTT延长。我们得出结论，在我院对所有术前神经外科患者进行常规筛查没有必要。
