Department of Paediatric Anaesthesia and Intensive Care, Queen Silvia's Children Hospital, 416 85 Gothenburg, Sweden.
Anesth Analg. 2011 Jan;112(1):30-6. doi: 10.1213/ANE.0b013e3181fe4674. Epub 2010 Nov 3.
The majority of pediatric cardiac surgery patients receive blood transfusions. We hypothesized that the routine use of intraoperative thromboelastometry to guide transfusion decisions would reduce the overall proportion of patients receiving transfusions in pediatric cardiac surgery.
One hundred pediatric cardiac surgery patients were included in the study. Fifty patients (study group) were prospectively included and compared with 50 procedure- and age-matched control patients (control group). In the study group, thromboelastometry, performed during cardiopulmonary bypass, guided intraoperative transfusions. Intraoperative and postoperative transfusions of packed red blood cells, fresh frozen plasma, platelets, and fibrinogen concentrates, and postoperative blood loss and hemoglobin levels were compared between the 2 groups.
The proportion of patients receiving any intraoperative or postoperative transfusion of packed red blood cells, fresh frozen plasma, platelets, or fibrinogen concentrates was significantly lower in the study group than in the control group (32 of 50 [64%] vs 46 of 50 [92%], respectively; P < 0.001). Significantly fewer patients in the study group received transfusions of packed red blood cells (58% vs 78%, P = 0.032) and plasma (14% vs 78%, P < 0.001), whereas more patients in the study group received transfusions of platelets (38% vs 12%, P = 0.002) and fibrinogen concentrates (16% vs 2%, P = 0.015). Neither postoperative blood loss nor postoperative hemoglobin levels differed significantly between the study group and the control group.
The results suggest that routine use of intraoperative thromboelastometry in pediatric cardiac surgery to guide transfusions is associated with a reduced proportion of patients receiving transfusions and an altered transfusion pattern.
大多数儿科心脏手术患者需要输血。我们假设术中血栓弹力图指导输血决策的常规使用将减少儿科心脏手术中接受输血的患者的总体比例。
本研究纳入了 100 名儿科心脏手术患者。50 名患者（研究组）前瞻性纳入，并与 50 名手术和年龄匹配的对照患者（对照组）进行比较。在研究组中，体外循环期间进行血栓弹力图检查，指导术中输血。比较两组患者的术中及术后输注红细胞、新鲜冰冻血浆、血小板和纤维蛋白原浓缩物的情况，以及术后失血量和血红蛋白水平。
研究组患者接受任何术中或术后输注红细胞、新鲜冰冻血浆、血小板或纤维蛋白原浓缩物的比例明显低于对照组（分别为 32/50 [64%]比 46/50 [92%]，P<0.001）。研究组患者输注红细胞（58%比 78%，P=0.032）和血浆（14%比 78%，P<0.001）的比例明显较低，而输注血小板（38%比 12%，P=0.002）和纤维蛋白原浓缩物（16%比 2%，P=0.015）的比例较高。研究组和对照组患者的术后失血量和术后血红蛋白水平无显著差异。
结果表明，在儿科心脏手术中常规使用术中血栓弹力图指导输血与接受输血的患者比例降低以及输血模式改变相关。
