Mulaj Muj, Faraoni David, Willems Ariane, Sanchez Torres Cristel, Van der Linden Philippe
Department of Anesthesiology, Centre Hospitalier Universitaire Brugmann and Queen Fabiola Children's University Hospital, Brussels, Belgium.
Department of Anesthesiology, Centre Hospitalier Universitaire Brugmann and Queen Fabiola Children's University Hospital, Brussels, Belgium.
Ann Thorac Surg. 2014 Aug;98(2):662-7. doi: 10.1016/j.athoracsur.2014.04.089. Epub 2014 Jun 24.
Red blood cell (RBC) transfusion is frequently required in pediatric cardiac surgery and is associated with altered outcome and increased costs. Determining which factors predict transfusion in this context will enable clinicians to adopt strategies that will reduce the risk of RBC transfusion. This study aimed to assess predictive factors associated with RBC transfusion in children undergoing low-risk cardiac surgery with cardiopulmonary bypass (CPB).
Children undergoing surgery to repair ventricular septal defect or atrioventricular septal defect from 2006 to 2011 were included in this retrospective study. Demography, preoperative laboratory testing, intraoperative data, and RBC transfusion were reviewed. Univariate and multivariate logistic regression analysis were used to define factors that were able to predict RBC transfusion. Then, we employed receiver operating characteristic analysis to design a predictive score.
Among the 334 children included, 261 (78%) were transfused. Age (<18 months), priming volume of the CPB (>43 mL/kg), type of oxygenator used, minimal temperature reached during CPB (<32°C), and preoperative hematocrit (<34%) were independently associated with RBC transfusion in the studied population. A predictive score 2 or greater was the best predictor of RBC transfusion.
The present study identified several factors that were significantly associated with perioperative RBC transfusion. Based on these factors, we designed a predictive score that can be used to develop a patient-based blood management program with the aim of reducing the incidence of RBC transfusion.
小儿心脏手术中经常需要输注红细胞（RBC），这与预后改变和成本增加相关。确定在此背景下哪些因素可预测输血将使临床医生能够采取策略降低RBC输血风险。本研究旨在评估在接受低风险体外循环（CPB）心脏手术的儿童中与RBC输血相关的预测因素。
本回顾性研究纳入了2006年至2011年期间接受室间隔缺损或房室间隔缺损修复手术的儿童。回顾了人口统计学、术前实验室检查、术中数据和RBC输血情况。采用单因素和多因素逻辑回归分析来确定能够预测RBC输血的因素。然后，我们采用受试者工作特征分析来设计一个预测评分。
在所纳入的334名儿童中，261名（78%）接受了输血。年龄（<18个月）、CPB预充量（>43 mL/kg）、使用的氧合器类型、CPB期间达到的最低温度（<32°C）和术前血细胞比容（<34%）在研究人群中与RBC输血独立相关。预测评分为2分或更高是RBC输血的最佳预测指标。
本研究确定了几个与围手术期RBC输血显著相关的因素。基于这些因素，我们设计了一个预测评分，可用于制定基于患者的血液管理方案，以降低RBC输血的发生率。
