Xiao Wei, Fu Wenya, Wang Tianlong, Zhao Lei
Department of Anesthesiology, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China.
J Clin Anesth. 2016 Sep;33:149-55. doi: 10.1016/j.jclinane.2016.02.040. Epub 2016 Apr 29.
Hemispherectomy is an established surgical procedure to treat medically refractory epilepsy caused by diffuse hemispheric diseases. The most common complication of hemispherectomy is intraoperative bleeding. Perioperative allogeneic blood transfusion increases mortality and morbidity in pediatric patients. Etiologies of massive blood loss during hemispherectomy include intraoperative diffuse vascular damage, antileptic drugs induced coagulation dysfunction, hyperfibrinolysis and dilutional coagulopathy. Great efforts should be made to minimize the need of blood transfusion. We present a series of three cases undergoing pediatric hemispherectomy, where a new algorithm was employed to manage coagulation. This new algorithm was mainly based on timely thrombelastogram analyses guided clotting factors supplement and continuous administration of tranexamic acid. In our cases, the amount of blood loss and subsequent allogeneic blood transfusion seemed to be less than literature reported.
大脑半球切除术是一种成熟的外科手术，用于治疗由弥漫性半球疾病引起的药物难治性癫痫。大脑半球切除术最常见的并发症是术中出血。围手术期异体输血会增加儿科患者的死亡率和发病率。大脑半球切除术期间大量失血的病因包括术中弥漫性血管损伤、抗癫痫药物引起的凝血功能障碍、高纤维蛋白溶解和稀释性凝血病。应尽最大努力减少输血需求。我们报告了一系列三例接受儿科大脑半球切除术的病例，其中采用了一种新的算法来管理凝血。这种新算法主要基于及时的血栓弹力图分析，指导凝血因子补充和持续使用氨甲环酸。在我们的病例中，失血量和随后的异体输血量似乎比文献报道的要少。
