Nguyen Thanh T, Lam Humphrey V, Phillips Maxie, Edwards Clasherrol, Austin Thomas M
Division of Pediatric Anesthesiology, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA.
Paediatr Anaesth. 2015 Mar;25(3):294-300. doi: 10.1111/pan.12600. Epub 2014 Dec 11.
Craniofacial reconstructive surgery for craniosynostosis is associated with large blood loss and intraoperative transfusion. This blood loss may continue through the initial postoperative period, potentially resulting in transfusion postoperatively. The purpose of this study is to determine if there is an association between any modifiable intraoperative factors and postoperative blood transfusion in this patient population.
A cohort of 55 pediatric patients who underwent primary craniofacial reconstruction at Vanderbilt Children's Hospital from January 1, 2013 to April 31, 2014 was analyzed. The authors analyzed 20 different demographic and perioperative variables for statistical associations with postoperative PRBC transfusion using multiple logistic regression with optimal models being selected by Bayesian model averaging.
The optimal regression model only included initial PACU Hct as a predictor and showed a significant association between this variable and postoperative PRBC transfusion (odds ratio 0.69, 95% CI 0.55-0.87, P = 0.0016). Based on the average decrease in postoperative hematocrit (Hct) and the postoperative transfusion trigger, an initial PACU Hct threshold of 30 was calculated. In our patient sample, an initial PACU Hct above 30 was associated with a 50% decrease in the absolute risk of receiving a PRBC transfusion postoperatively.
Based on this retrospective analysis, it may be justifiable to transfuse residual volume from previously exposed intraoperative PRBCs to a Hct above 30 to decrease the likelihood of subsequent blood transfusions from different donors in the postoperative period.
颅缝早闭的颅面重建手术会导致大量失血和术中输血。这种失血可能会持续到术后初期，有可能导致术后输血。本研究的目的是确定在该患者群体中，任何可改变的术中因素与术后输血之间是否存在关联。
分析了2013年1月1日至2014年4月31日在范德比尔特儿童医院接受初次颅面重建的55例儿科患者队列。作者分析了20种不同的人口统计学和围手术期变量，使用多因素逻辑回归分析与术后红细胞输注的统计关联，并通过贝叶斯模型平均法选择最佳模型。
最佳回归模型仅将术后麻醉恢复室（PACU）初始血细胞比容作为预测指标，该变量与术后红细胞输注之间存在显著关联（比值比0.69，95%可信区间0.55 - 0.87，P = 0.0016）。根据术后血细胞比容（Hct）的平均下降和术后输血触发点，计算出术后麻醉恢复室初始血细胞比容阈值为30。在我们的患者样本中，术后麻醉恢复室初始血细胞比容高于30与术后接受红细胞输注的绝对风险降低50%相关。
基于这项回顾性分析，将先前术中暴露的红细胞残余量输注至血细胞比容高于30，以降低术后不同供血者后续输血的可能性可能是合理的。
