Peng Yuanzhi, Du Jianer, Zhao Xuan, Shi Xueyin, Wang Yingwei
Department of Anesthesiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong, Shanghai, 200092, China.
Department of Anesthesiology, Huashan Hospital, FuDan University, Shanghai, 200040, China.
BMC Anesthesiol. 2017 Apr 27;17(1):62. doi: 10.1186/s12871-017-0353-z.
Volume replacement therapy with colloid is still worth studying in major pediatric surgery with potential risk of bleeding. This study assessed the effects of 6% hydroxyethyl starch (HES) 130/0.4 and 5% Human Albumin (HA) on coagulation tested by thromboelastography (TEG) during elective intracranial tumor surgery in pediatric patients.
In this randomized controlled trial, 60 patients undergoing intracranial tumor resection under general anesthesia were assigned to HES and HA groups (n = 30), and administered preloads of 20 mL · kg HES 130/0.4 and 5% HA, respectively, prior to dura opening. Primary outcomes were perioperative thromboelastography findings, and hemodynamic and hematological parameters. Blood transfusion, perioperative fluid balance, intracranial pressure, mortality, intensive care unit stay, and hospital stay were also assessed.
TEG parameters did not differ after preloading compared to baseline values in either group, except for a decrease in maximum amplitude immediately after infusion (HES group, 57.6 ± 6.0 mm vs. 50.9 ± 9.2 mm; HA group, 60.1 ± 7.9 mm vs. 56.6 ± 7.1 mm; p < 0.01), which was restored to preoperative levels 1 h after fluid infusion. Total perioperative fluid balance, blood loss or transfusion, intracranial pressure, and hematological and hemodynamic variables were similar between both groups (p > 0.05). Mortality, length of hospital stay, and clinical complications were similar between both groups.
These findings suggest that HES and HA might have no significant differences regarding coagulation as assessed by TEG during pediatric intracranial tumor surgery with 20 ml/kg volume pre-loading, which can maintain stable hemodynamics and may represent a new avenue for volume therapy during brain tumor resection in pediatrics.
ChiCTR-IPR- 16009333 , retrospectively registered October 8, 2016.
在有潜在出血风险的小儿大手术中，胶体液替代疗法仍值得研究。本研究评估了6%羟乙基淀粉（HES）130/0.4和5%人血白蛋白（HA）对小儿择期颅内肿瘤手术期间通过血栓弹力图（TEG）检测的凝血功能的影响。
在这项随机对照试验中，60例接受全身麻醉下颅内肿瘤切除术的患者被分为HES组和HA组（n = 30），并在硬脑膜打开前分别给予20 mL·kg的HES 130/0.4和5% HA预负荷量。主要结局指标为围手术期血栓弹力图结果、血流动力学和血液学参数。还评估了输血情况、围手术期液体平衡、颅内压、死亡率、重症监护病房停留时间和住院时间。
与基线值相比，两组预负荷后TEG参数均无差异，但输注后立即出现最大振幅下降（HES组，57.6±6.0 mm对50.9±9.2 mm；HA组，60.1±7.9 mm对56.6±7.1 mm；p < 0.01），输液后1小时恢复到术前水平。两组围手术期总液体平衡、失血量或输血量、颅内压以及血液学和血流动力学变量相似（p > 0.05）。两组的死亡率、住院时间和临床并发症相似。
这些发现表明，在小儿颅内肿瘤手术中，以20 ml/kg的容量预负荷，通过TEG评估，HES和HA在凝血方面可能没有显著差异，这可以维持稳定的血流动力学，可能代表小儿脑肿瘤切除术中容量治疗的新途径。
ChiCTR-IPR-16009333（2016年10月8日回顾性注册）
