Pasternak Jeffrey J, Hertzfeldt Dana N, Stanger Sharm R, Walter Kirsten R, Werts Travis D, Marienau Mary E S, Lanier William L
Department of Anesthesiology, College of Medicine and School of Health Related Sciences, Mayo Clinic, Rochester, MN 55905, USA.
J Neurosurg Anesthesiol. 2008 Jan;20(1):15-20. doi: 10.1097/ANA.0b013e318155b1c4.
Disseminated intravascular coagulation (DIC) is reported in neurosurgical patients; however, the incidence of DIC after craniotomy procedures is unknown. Using a surgical database, we identified 3164 patients who underwent primary craniotomy at Mayo Clinic Rochester between January 1, 2000 and December 31, 2004. Potential cases of DIC in this population were identified using 3 search triggers, patients: (1) in whom the diagnosis of DIC was noted on their hospital discharge summary, (2) who received red blood cell-free blood products, or (3) in whom a blood fibrinogen or d-dimer concentration was assessed. Using criteria based on laboratory values, we estimated the incidence of DIC developing within 72 hours of primary craniotomy to be between 13 and 44 per 10,000 patients. Despite a low incidence of DIC, the associated mortality rate was 43% to 75%. Traumatic head injury was a significant risk factor for the development of DIC [odds ratio of trauma was in the range of 16 (95% confidence interval (CI)=5.3-49) to 29 (CI=4.0-204)]. Autologous salvaged blood was administered intraoperatively to 44 patients, and 1 of these developed DIC. Although this small sample of patients receiving salvaged blood requires caution in interpreting the results, the risk of DIC seemed to be greater with salvaged blood than without [odds ratio 24 (CI=2.5-237)]. In children, 2 of 3 patients who developed DIC had congenital malformations of the brain. Findings from this study suggest that DIC is rare after craniotomy, but is often associated with mortality.
据报道，神经外科患者会发生弥散性血管内凝血（DIC）；然而，开颅手术后DIC的发生率尚不清楚。我们利用一个手术数据库，确定了2000年1月1日至2004年12月31日期间在罗切斯特梅奥诊所接受初次开颅手术的3164例患者。通过3个搜索触发条件来确定该人群中可能的DIC病例：（1）出院小结中记录有DIC诊断的患者；（2）接受过无红细胞血液制品的患者；（3）检测过血纤维蛋白原或D-二聚体浓度的患者。根据实验室值标准，我们估计初次开颅术后72小时内发生DIC的发生率为每10000例患者中有13至44例。尽管DIC发生率较低，但其相关死亡率为43%至75%。创伤性颅脑损伤是发生DIC的一个重要危险因素[创伤的优势比在16（95%置信区间（CI）=5.3-49）至29（CI=4.0-204）之间]。术中对44例患者输注了自体回收血，其中1例发生了DIC。虽然这一小部分接受回收血的患者样本在解释结果时需要谨慎，但接受回收血的患者发生DIC的风险似乎比未接受者更大[优势比24（CI=2.5-237）]。在儿童中，发生DIC的3例患者中有2例患有先天性脑畸形。本研究结果表明，开颅术后DIC很少见，但常与死亡率相关。
