Zhang Na, Xu Yingyi, Xu Xinke, Chen Cheng, Guo Yubing, Tan Yonghong
1Departments of1Anesthesiology and.
2Stomatology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China.
J Neurosurg Pediatr. 2023 Jan 20;31(4):290-297. doi: 10.3171/2022.12.PEDS22252. Print 2023 Apr 1.
Intraoperative blood loss is a major challenge in pediatric brain tumor removal. Several clinical and surgical factors may influence the occurrence of intraoperative blood loss and blood transfusion. This study aimed to identify the risk factors of intraoperative blood loss and intraoperative red blood cell (RBC) transfusion for pediatric patients undergoing brain tumor removal.
A total of 297 pediatric patients undergoing brain tumor removal were selected in this retrospective, singlecenter study. Demographic data, laboratory data, imaging data, and surgical records were collected, and then independent risk factors for intraoperative blood loss and transfusion were identified using multivariate stepwise regression analysis.
The median intraoperative blood loss in our cohort was 23.1 ml/kg (IQR 10.0-60.0 ml/kg). In total, 284 (95.6%) patients received intraoperative RBC transfusion, with a median amount of 0.2 U/kg (IQR 0.0-2.6 U/kg). Age (β = -0.189; 95% CI [-1.359, -0.473]; p < 0.001); preoperative hemoglobin level (β = -0.141; 95% CI [-1.528, -0.332]; p = 0.003); anesthesia time (β = 0.189; 95% CI [0.098, 0.302]; p < 0.001); unclear tumor boundary (β = 0.100; 95% CI [2.067, 41.053]; p = 0.031); tumor size (β = 0.390; 95% CI [14.706, 24.342]; p < 0.001); and intraoperative continuous infusion of vasopressor (β = 0.155; 95% CI [13.364, 52.400]; p = 0.001) were independent predictors of intraoperative blood loss. Independent predictors of the need for RBC transfusion included age (β = -0.268; 95% CI [-0.007, -0.004]; p < 0.001); preoperative hemoglobin level (β = -0.117; 95% CI [-0.005, -0.001]; p = 0.003); anesthesia time (β = 0.221; 95% CI [0.001, 0.001]; p < 0.001); unclear tumor boundary (β = 0.110; 95% CI [0.024, 0.167]; p = 0.010); tumor size (β = 0.370; 95% CI [0.056, 0.092]; p < 0.001); intraoperative continuous infusion of vasopressor (β = 0.157; 95% CI [0.062, 0.205]; p < 0.001); and tumor grade (β = 0.107; 95% CI [0.007, 0.062]; p = 0.014).
Overall, age, preoperative hemoglobin, tumor size, anesthesia time, continuous infusion of vasopressors, and unclear tumor boundary were the main determinants for intraoperative blood loss and RBC transfusion in pediatric patients undergoing brain tumor removal. Clinical trial registration no.: ChiCTR1900024803 (ChiCTR.org).
术中失血是小儿脑肿瘤切除手术中的一项重大挑战。若干临床和手术因素可能会影响术中失血及输血的发生情况。本研究旨在确定接受脑肿瘤切除手术的小儿患者术中失血及术中红细胞（RBC）输血的危险因素。
本项回顾性单中心研究共纳入297例接受脑肿瘤切除手术的小儿患者。收集人口统计学数据、实验室数据、影像学数据及手术记录，然后采用多因素逐步回归分析确定术中失血及输血的独立危险因素。
我们队列中的术中失血量中位数为23.1 ml/kg（四分位间距10.0 - 60.0 ml/kg）。共有284例（95.6%）患者接受了术中红细胞输血，输血量中位数为0.2 U/kg（四分位间距0.0 - 2.6 U/kg）。年龄（β = -0.189；95%置信区间[-1.359, -0.473]；p < 0.001）；术前血红蛋白水平（β = -0.141；95%置信区间[-1.528, -0.332]；p = 0.003）；麻醉时间（β = 0.189；95%置信区间[0.098, 0.302]；p < 0.001）；肿瘤边界不清（β = 0.100；95%置信区间[2.067, 41.053]；p = 0.031）；肿瘤大小（β = 0.390；95%置信区间[14.706, 24.342]；p < 0.001）；以及术中持续输注血管升压药（β = 0.155；95%置信区间[13.364, 52.400]；p = 0.001）是术中失血的独立预测因素。红细胞输血需求的独立预测因素包括年龄（β = -0.268；95%置信区间[-0.007, -0.004]；p < 0.001）；术前血红蛋白水平（β = -0.117；95%置信区间[-0.005, -0.001]；p = 0.003）；麻醉时间（β = 0.221；95%置信区间[0.001, 0.001]；p < 0.001）；肿瘤边界不清（β = 0.110；95%置信区间[0.024, 0.167]；p = 0.010）；肿瘤大小（β = 0.370；95%置信区间[0.056, 0.092]；p < 0.001）；术中持续输注血管升压药（β = 0.157；95%置信区间[0.062, 0.205]；p < 0.001）；以及肿瘤分级（β = 0.107；95%置信区间[0.007, 0.062]；p = 0.014）。
总体而言，年龄、术前血红蛋白、肿瘤大小、麻醉时间、血管升压药持续输注以及肿瘤边界不清是接受脑肿瘤切除手术的小儿患者术中失血及红细胞输血的主要决定因素。临床试验注册号：ChiCTR1900024803（ChiCTR.org）。
