Vitale Michael G, Privitera David M, Matsumoto Hiroko, Gomez Jaime A, Waters Linda M, Hyman Joshua E, Roye David P
Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Spine (Phila Pa 1976). 2007 Nov 15;32(24):2662-7. doi: 10.1097/BRS.0b013e31815a59cf.
This is a retrospective cohort study examining 61 patients with neurogenic scoliosis who underwent anterior and/or posterior spinal instrumentation at the age of 18 and younger.
The purpose of this study is to investigate this finding further by analyzing the effect of recombinant human erythropoietin (rhEPO) on hematocrit, transfusion and complication rates, and the length of intensive care unit (ICU) days in patients with neurogenic scoliosis.
The preoperative use of rhEPO has been shown to decrease perioperative transfusion requirements in many adult and pediatric patients. A recent study at our institution demonstrated the efficacy of rhEPO in pediatric idiopathic scoliosis patients, but suggested the possibility of an "erythropoietin resistance" in the pediatric neurogenic scoliosis population.
The patients' age at the time of surgery, gender, Cobb angle, erythropoietin administration and dosage, hematocrit levels, type of surgery, intraoperative blood loss, duration of surgery, number of vertebrae fused, comorbidities, complications, transfusion status, and the length of ICU days were collected.
Thirty-five (57.3%) children received preoperative rhEPO, whereas 26 patients (42.7%) did not receive rhEPO. The mean preoperative and discharge hematocrit levels in the patients treated with rhEPO were significantly higher than the non-rhEPO group (P = 0.05). There were no significant difference in likelihood of transfusion, complications, and the length of ICU days between the rhEPO and the non-rhEPO groups. A multivariate analysis demonstrated that the number of fused vertebral levels maintained its significance (P = 0.044) and surgical time had a trend toward significance (P = 0.051) in predicting likelihood of transfusion.
The use of rhEPO effectively stimulated erythropoiesis in these patients and yet demonstrated no significant clinical benefit in reducing the likelihood of transfusion in neurogenic patients in this study. More research is necessary to design a transfusion risk reduction protocols that will minimize the exposure of neurogenic scoliosis patients to allogeneic blood products.
这是一项回顾性队列研究，研究对象为61例18岁及以下接受前路和/或后路脊柱内固定术的神经源性脊柱侧弯患者。
本研究的目的是通过分析重组人促红细胞生成素（rhEPO）对神经源性脊柱侧弯患者血细胞比容、输血及并发症发生率以及重症监护病房（ICU）住院天数的影响，进一步探究这一发现。
术前使用rhEPO已被证明可降低许多成年和儿科患者的围手术期输血需求。我们机构最近的一项研究证明了rhEPO在小儿特发性脊柱侧弯患者中的疗效，但提示小儿神经源性脊柱侧弯人群可能存在“促红细胞生成素抵抗”。
收集患者手术时的年龄、性别、Cobb角、促红细胞生成素的给药情况及剂量、血细胞比容水平、手术类型、术中失血量、手术持续时间、融合椎体数量、合并症、并发症、输血情况以及ICU住院天数。
35例（57.3%）儿童接受了术前rhEPO治疗，而26例患者（42.7%）未接受rhEPO治疗。接受rhEPO治疗的患者术前及出院时的平均血细胞比容水平显著高于未接受rhEPO治疗的组（P = 0.05）。rhEPO组和未接受rhEPO治疗组在输血可能性、并发症及ICU住院天数方面无显著差异。多因素分析表明，融合椎体水平数在预测输血可能性方面仍具有显著性（P = 0.044），手术时间有趋于显著性的趋势（P = 0.051）。
在本研究中，rhEPO的使用有效刺激了这些患者的红细胞生成，但在降低神经源性患者输血可能性方面未显示出显著的临床益处。需要更多研究来设计降低输血风险的方案，以尽量减少神经源性脊柱侧弯患者接触异体血制品的情况。
