Pouliquen J C, Jean N, Noat M, Boyer J M, Yannoutsos H
Service d'Orthopédie et Traumatologie pédiatriques, Faculté de Médecine Paris-Ouest, Garches.
Chirurgie. 1990;116(3):303-11.
The authors review 145 operations utilizing the Cotrel-Dubousset technique for scoliosis and/or cyphosis over a period of 4 years. From 1985 to 1989, the number of patients who received no homologous blood rose from 0% to 85% for the totality of cases. Inversely, the average quantity per patient of homologous blood used for transfusion decreased from 3,564 ml to 194 ml, ie. -94%. Among the 145 operated patients, 47 (33%) have never received a transfusion, whether or not an autotransfusion procedure was planned; out of the 41 children prepared with preoperative autologous sampling, 39 (97%) received no homologous blood. The authors study the various means used to achieve these results in a particularly hemorrhagic surgical procedure: low blood pressure techniques, intraoperative installation and warming, peroperative recovery of blood, decrease in duration and bleeding using natural coral to avoid removing an iliac bone graft, study of evoked potentials to prevent intraoperative awakening, better postoperative control of bleeding by means of an original drain tube. As a conclusion, they state that, owing to better coordination between surgery, anesthesiology and blood biology, such definite progress may be extended to other operations in future.
作者回顾了4年间采用Cotrel-Dubousset技术治疗脊柱侧凸和/或脊柱后凸的145例手术。从1985年到1989年，总体病例中未接受异体血的患者比例从0%上升到85%。相反，每位患者用于输血的异体血平均量从3564毫升降至194毫升，即下降了94%。在145例接受手术的患者中，47例（33%）从未接受过输血，无论是否计划进行自体输血；在41例术前进行自体采血的儿童中，39例（97%）未接受异体血。作者研究了在这种出血性特别强的外科手术中取得这些成果所采用的各种方法：低血压技术、术中血液回输及加温、术中血液回收、使用天然珊瑚避免取髂骨植骨以缩短手术时间和减少出血、监测诱发电位以防止术中苏醒、通过一种新型引流管更好地控制术后出血。作为结论，他们指出，由于外科、麻醉和血液生物学之间更好的协作，这种明确的进展未来可能会推广到其他手术中。
