Park Chang, Wormald Justin, Miranda Benjamin H, Ong Juling, Hare Alison, Eccles Simon
Department of Craniofacial, Plastic and Reconstructive Surgery, Chelsea and Westminster NHS Hospital Foundation Trust, London, United Kingdom.
J Craniofac Surg. 2018 Jan;29(1):112-115. doi: 10.1097/SCS.0000000000004098.
Craniosynostosis has an incidence of 1 in 2000 to 2500 live births and may be corrected through several methods including total calvarial remodeling and frontal orbital advancement remodeling. Blood loss during craniosynostosis surgery can be substantial, ranging from 20% to 500% of total circulating volume with a high associated risk of transfusion-related adverse events. The authors performed a retrospective analysis of all patients undergoing surgery for craniosynostosis at a tertiary pediatric craniofacial center with a focus on blood loss and subsequent transfusion.The authors reviewed 40 patients with craniosynostosis >16 years at a single-center. Data on perioperative blood loss and transfusion were obtained, including pre-, intra-, and postoperative hemoglobin, hematocrit, and use of tranexamic acid. The authors calculated estimated percentage of circulating red cell volume lost and transfused.The majority of patients had sagittal synostosis and underwent total calvarial remodeling (n = 20); the rest underwent frontal orbital advancement remodeling (n = 19) or lambdoid correction (n = 1). The average estimated volume red cell loss was 77% of circulating volume and 90% of patients received blood transfusion with an average 88.3% transfusion of circulating red cell volume. Longer operative time, younger age, and lower weight predisposed to >50% blood volume transfusion (P = 0.032, <0.005, <0.005 respectively).This single-center observational study reports red cell volume loss and volume of transfusion in children undergoing surgical correction of craniosynostosis. Red cell volume loss was comparative to that in the literature and in this cohort longer operative time, younger age, and lower weight predisposed to >50% blood volume transfusion.
颅缝早闭在每2000至2500例活产婴儿中的发病率为1例，可通过多种方法进行矫正，包括全颅骨重塑和额眶前移重塑。颅缝早闭手术期间的失血量可能很大，占总循环血量的20%至500%，输血相关不良事件的风险很高。作者对一家三级儿科颅面中心所有接受颅缝早闭手术的患者进行了回顾性分析，重点关注失血量和随后的输血情况。作者回顾了单中心40例年龄>16岁的颅缝早闭患者。获取围手术期失血量和输血的数据，包括术前、术中和术后的血红蛋白、血细胞比容以及氨甲环酸的使用情况。作者计算了估计的循环红细胞体积丢失和输注的百分比。大多数患者患有矢状缝早闭并接受了全颅骨重塑（n = 20）；其余患者接受了额眶前移重塑（n = 19）或人字缝矫正（n = 1）。平均估计红细胞丢失量为循环血量的77%，90%的患者接受了输血，平均输注循环红细胞体积的88.3%。手术时间较长、年龄较小和体重较低易导致输血超过循环血量的50%（P分别为0.032、<0.005、<0.005）。这项单中心观察性研究报告了接受颅缝早闭手术矫正的儿童的红细胞体积丢失和输血量。红细胞体积丢失与文献报道相当，在该队列中，手术时间较长、年龄较小和体重较低易导致输血超过循环血量的50%。
