Ann Arbor, Mich. From the Department of Surgery, Section of Plastic Surgery, and the Department of Biostatistics, University of Michigan; and the International Center for Automotive Medicine.
Plast Reconstr Surg. 2013 Sep;132(3):403e-412e. doi: 10.1097/PRS.0b013e31829ad31f.
Estimates of blood loss during craniosynostosis surgeries have ranged from 42 to 126 percent of infant's total blood volume. Currently, no risk model has been developed to determine the likelihood of needing a blood transfusion. The authors propose an objective model, based on patients' three-dimensional anatomical characteristics, to stratify the likelihood of needing perioperative packed red blood cells.
High-throughput image analysis from already ordered preoperative computed tomographic scans was used to reconstruct the three-dimensional anatomy of the temporalis muscle and overlying temporal fat pad. Using these morphomic measurements, the authors created a risk assessment model of the amount of packed red blood cells infused based on morphomic variations in temporal soft tissue.
The authors evaluated 139 infants with nonsyndromic craniosynostosis from the University of Michigan Health System. Results show the need for blood transfusion ranged from 94.1 percent among patients in the smallest quartile for temporal fat pad volume compared with 65.7 percent among the group with the largest quartile for temporal fat pad volume (p = 0.0057). Using multivariable linear regression, temporal fat pad volume (p = 0.012) and fat pad thickness (p = 0.036) were independent predictors for amount of packed red blood cells required.
The authors demonstrate that patients with diminished temporal fat pad volume are significantly more likely to need increased packed red blood cell transfusions. In addition, by use of multivariable linear regression, their data suggest that temporal fat pad volume and thickness were independent predictors for the amount of required transfusion of packed red blood cells.
颅缝早闭手术中失血量的估计范围为婴儿总血量的 42%至 126%。目前，尚未开发出确定是否需要输血的风险模型。作者提出了一种基于患者三维解剖特征的客观模型，以分层确定围手术期需要输注浓缩红细胞的可能性。
使用已订购的术前计算机断层扫描的高通量图像分析来重建颞肌和上方颞脂肪垫的三维解剖结构。使用这些形态学测量值，作者基于颞部软组织的形态变化创建了一个基于形态学变化的浓缩红细胞输注量风险评估模型。
作者评估了来自密歇根大学健康系统的 139 名非综合征性颅缝早闭婴儿。结果显示，与颞脂肪垫体积最大四分位数组的 65.7%相比，颞脂肪垫体积最小四分位数组的输血需求为 94.1%（p=0.0057）。使用多元线性回归，颞脂肪垫体积（p=0.012）和脂肪垫厚度（p=0.036）是需要输注浓缩红细胞量的独立预测因子。
作者证明，颞脂肪垫体积减小的患者明显更有可能需要增加浓缩红细胞输血。此外，通过使用多元线性回归，他们的数据表明颞脂肪垫体积和厚度是需要输注浓缩红细胞量的独立预测因子。
