影响髋关节发育不良行开放手术的儿科患者输血需求的因素。

Factors affecting need for blood transfusion in paediatric patients undergoing open surgery for hip dysplasia.

机构信息

Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Texas, USA.

School of Medicine, Houston, Texas, USA.

出版信息

Vox Sang. 2022 Dec;117(12):1384-1390. doi: 10.1111/vox.13372. Epub 2022 Oct 27.

DOI:10.1111/vox.13372

PMID:36300858

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9772120/

Abstract

BACKGROUND AND OBJECTIVES

The management of intraoperative blood loss in the surgical treatment of paediatric hip dysplasia is resource intensive. There are numerous clinical factors that impact the need for intraoperative transfusion. Identification of patient and surgical factors associated with increased blood loss may reduce the unnecessary use of resources. This study aimed to identify factors predictive of intraoperative transfusion in children undergoing hip dysplasia surgery.

MATERIALS AND METHODS

This is a single-centre retrospective review of patients undergoing surgery for hip dysplasia from 1 January 2012 to 15 April 2021. Patient demographic factors, anaesthetic, surgical and transfusion histories were reviewed. Multivariable logistic regression analysis was performed to identify factors predictive of allogeneic red blood cell transfusion requirements during the intraoperative period.

RESULTS

This study includes 595 patients who underwent open surgery for hip dysplasia, including 297 (52.6%) classified as developmental dysplasia (DD) and 268 (47.3%) as neuromuscular (NM) with a mean age of 9.1 years (interquartile range 3-14). Intraoperative allogeneic transfusion was identified in 26/297 (8.8%) DD and 73/268 (27.2%) NM patients. Adjusted factors associated with increased odds of intraoperative transfusion were NM (odds ratio [OR] = 2.96, 95% confidence interval [CI] [1.76, 5.00]) and the number of osteotomies performed (OR = 1.82/osteotomy, 95% CI [1.40, 2.35]). Adjusted factors that reduced the odds of transfusion were the use of antifibrinolytics (OR = 0.35, 95% CI [0.17, 0.71]) and regional anaesthesia (OR = 0.52, 95% CI [0.29, 0.94]).

CONCLUSION

For children undergoing surgery for hip dysplasia, the number of osteotomies performed is predictive of the need for allogeneic blood transfusion. Antifibrinolytics and regional anaesthesia are associated with reduced risk for allogeneic blood transfusion. Blood management initiatives, such a preoperative optimization of haemoglobin and the use of antifibrinolytics, could target patients at increased risk of intraoperative bleeding and transfusion.

摘要

背景与目的

在小儿髋关节发育不良的手术治疗中，术中失血量的管理需要耗费大量资源。有许多临床因素会影响术中输血的需求。确定与失血增加相关的患者和手术因素可能会减少不必要的资源使用。本研究旨在确定接受髋关节发育不良手术的儿童术中输血的预测因素。

材料与方法

这是一项单中心回顾性研究，纳入 2012 年 1 月 1 日至 2021 年 4 月 15 日期间接受髋关节发育不良手术的患者。回顾患者的人口统计学因素、麻醉、手术和输血史。采用多变量逻辑回归分析确定术中异体红细胞输血需求的预测因素。

结果

本研究纳入 595 例行髋关节发育不良开放手术的患者，其中 297 例（52.6%）为发育性髋关节发育不良（DD），268 例（47.3%）为神经肌肉性（NM），平均年龄为 9.1 岁（四分位间距 3-14）。在 297 例 DD 患者中，有 26 例（8.8%）和在 268 例 NM 患者中，有 73 例（27.2%）术中需要异体输血。调整后的因素中，与术中输血风险增加相关的因素包括 NM（比值比 [OR] 2.96，95%置信区间 [CI] 1.76-5.00）和实施的截骨术数量（OR 1.82/截骨术，95%CI 1.40-2.35）。减少输血风险的调整因素包括使用抗纤溶剂（OR 0.35，95%CI 0.17-0.71）和区域麻醉（OR 0.52，95%CI 0.29-0.94）。