Haas Thorsten, Korte Wolfgang, Spielmann Nelly, Mauch Jacqueline, Madjdpour Caveh, Schmugge Markus, Weiss Markus
Department of Anaesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, Switzerland.
Paediatr Anaesth. 2012 Jul;22(7):641-6. doi: 10.1111/j.1460-9592.2011.03709.x. Epub 2011 Sep 20.
Acquired deficiency of FXIII because of perioperative hemodilution has been described several times in adults; however, data in children are scarce. We performed a prospective observational trial to evaluate the intraoperative course of FXIII in children undergoing elective major surgery.
Blood samples were repeatedly taken from 46 children aged 0.3-16 years undergoing major surgery. Concentrations of FXIII and fibrinogen, thrombelastometry by ROTEM®, and cell count were assessed intraoperatively.
A significant decrease in FXIII concentration (median 60%; IQR 49-69%) was already noted at beginning of surgical procedures, while most ROTEM® traces remain unchanged. FXIII levels further deteriorated intraoperatively to minimal levels of 33% (15-61%). Lowest intraoperative clot strength (ExTEM) was 44 mm (34-50 mm), and fibrinogen plasma levels decreased to minimal levels of 130 mg·dl(-1) (95-160 mg·dl(-1) ). In 43 of 46 children, transfusion therapy was necessary. Despite of transfusion of fresh frozen plasma (cumulative total dose 22 ml·kg(-1) [11-32 ml·kg(-1) ]) in 21 of 46 children, FXIII level remains low in all children till the end of surgery at levels of 39% (20-46%).
Coagulation factor XIII decreased early during major surgery owing to hemodilution. Overall intraoperative FXIII levels remain low despite of transfusion of fresh frozen plasma.
围手术期血液稀释导致的获得性FXIII缺乏在成人中已有多次报道；然而，儿童中的数据却很稀少。我们进行了一项前瞻性观察性试验，以评估接受择期大手术的儿童术中FXIII的变化过程。
对46名年龄在0.3 - 16岁接受大手术的儿童反复采集血样。术中评估FXIII和纤维蛋白原的浓度、使用ROTEM®进行血栓弹力图分析以及血细胞计数。
在手术开始时就已注意到FXIII浓度显著下降（中位数60%；四分位间距49 - 69%），而大多数ROTEM®曲线保持不变。术中FXIII水平进一步恶化至最低水平33%（15 - 61%）。术中最低凝血强度（ExTEM）为44毫米（34 - 50毫米），血浆纤维蛋白原水平降至最低水平130毫克·分升⁻¹（95 - 160毫克·分升⁻¹）。46名儿童中有43名需要输血治疗。尽管46名儿童中有21名输注了新鲜冰冻血浆（累积总剂量22毫升·千克⁻¹[11 - 32毫升·千克⁻¹]），但所有儿童直至手术结束时FXIII水平仍很低，为39%（20 - 46%）。
由于血液稀释，凝血因子XIII在大手术早期下降。尽管输注了新鲜冰冻血浆，但术中整体FXIII水平仍很低。
