Section of Pediatric Anesthesiology, Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Ave, Box 090, Aurora, CO, USA.
Department of Anesthesiology, Division of Pediatric Anesthesiology, Duke University Medical Center, Durham, NC, USA.
Can J Anaesth. 2019 May;66(5):512-526. doi: 10.1007/s12630-019-01307-w. Epub 2019 Feb 14.
Pediatric patients undergoing complex cranial vault reconstruction (CCVR) are at risk of significant perioperative blood loss requiring blood product transfusion. Minimizing allogeneic blood product transfusion is an important goal because of the associated risks and cost. The impact of patient and surgical variables on transfusion is unknown in this population. Our primary aim was to examine relationships between demographic and perioperative variables and blood product transfusion outcomes in CCVR.
The multicentre Pediatric Surgery Perioperative Registry was checked for children undergoing CCVR between June 2012 and September 2016. Univariable and multivariable analyses were performed examining patient, procedure, and blood conservation variables and their relationship to three outcomes: intraoperative red blood cell-containing product (RBC-CP) transfusion, total perioperative blood donor exposures, and transfusion-free hospitalization.
The registry search returned data from 1,814 cases. Age and surgical duration were the only variables significantly associated with all three outcomes studied. Predictors of reduced RBC-CP transfusion included lower American Society of Anesthesiologists (ASA) physical status and antifibrinolytic administration. Total cranial vault reconstruction, intraoperative vasoactive infusion, and presence of a tracheostomy predicted increased donor exposures. Increased body weight, higher preoperative hematocrit, and utilization of intraoperative cell saver and transfusion protocols were associated with transfusion-free hospitalization.
Clinical factors associated with increased allogeneic blood product transfusion in pediatric CCVR include: age ≤ 24 months, ASA status ≥ III, preoperative anemia, prolonged surgical duration, lack of intraoperative antifibrinolytic use, lack of intraoperative cell saver use, and the lack of transfusion protocols.
接受复杂颅穹窿重建（CCVR）的儿科患者存在大量围手术期失血，需要输血治疗。由于相关风险和成本，减少同种异体血液产品的输注是一个重要目标。在该人群中，患者和手术变量对输血的影响尚不清楚。我们的主要目的是检查 CCVR 中患者和围手术期变量与血液制品输注结果之间的关系。
检查 2012 年 6 月至 2016 年 9 月期间接受 CCVR 的多中心小儿外科技能围手术期登记处的数据。进行单变量和多变量分析，检查患者、手术和血液保护变量及其与三个结果之间的关系：术中含红细胞产品（RBC-CP）输注、总围手术期供体暴露量和输血免费住院。
登记处搜索返回了 1814 例病例的数据。年龄和手术时间是与所有三个研究结果显著相关的唯一变量。减少 RBC-CP 输注的预测因素包括较低的美国麻醉师协会（ASA）身体状况和抗纤维蛋白溶解药物的应用。全颅穹窿重建、术中血管活性输注和存在气管造口术预测供体暴露增加。增加体重、较高的术前血细胞比容以及术中细胞保存器和输血方案的使用与输血免费住院相关。
与儿科 CCVR 中异体血液制品输注增加相关的临床因素包括：年龄≤24 个月、ASA 状态≥III、术前贫血、手术时间延长、术中未使用抗纤维蛋白溶解药物、术中未使用细胞保存器以及未使用输血方案。
