Feng H, Wang C X, Liu Q H, Xiao W, Wang T L
Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Zhonghua Yi Xue Za Zhi. 2024 Jun 18;104(23):2142-2147. doi: 10.3760/cma.j.cn112137-20231227-01495.
To evaluate the influence of thromboelastography-guided hemostatic algorithm on allogeneic transfusion requirements during pediatric hemispherectomy. Clinical data of 38 children who underwent hemispherectomy from January 1, 2011 to October 31, 2023 at Xuanwu Hospital of Capital Medical University were retrospective collected. Patients were divided into study group (=17) and control group (=21) according to whether thromboelastography was employed to guide hemostatic algorithm. Demographic data and surgical data were recorded. The primary outcomes were allogeneic transfusion rates, including RBC transfusion rate, plasma transfusion rate, and platelets transfusion rate. The second outcomes were estimated blood loss, postoperative seizures during hospitalization, thromboembolic events, and length of hospital stay. There were 13 boys and 4 girls with mean age of (5.7±3.3) years old in study group, and 16 boys and 5 girls with mean age of (7.4±3.4) years old in control group. The surgery duration, anesthesia duration and the proportion of prophylactic administration of tranexamic acid in study group were (424.5±98.5) min, (542.8±106.9) min, and 94.1% (16/17), which were higher than (353.1±85.3) min, (445.3±87.9) min, and 47.6% (10/21) in control group (all <0.05). The rates of intra- and perioperative allogeneic plasma transfusion in study group were 52.9% (9/17) and 64.7% (11/17) respectively, which were lower than 90.5% (19/21) and 95.2% (20/21) in control group (all <0.05). The ratio of fibrinogen concentrates administration in study group was 58.8% (10/17), which was higher than that in control group [4.8% (1/21), =0.001]. There were no statistically differences in intra- and perioperative allogeneic RBC transfusion rates between the two groups (all >0.05). No platelets were transfused in both groups. There were no statistically differences in estimated blood loss, postoperative seizures during hospitalization and the length of hospital stay between the two groups (all >0.05). No postoperative thromboembolic events were observed. Thromboelastography-guided hemostatic algorithm can reduce allogeneic plasma transfusion requirements but not RBC transfusion requirements during pediatric hemispherectomy.
评估血栓弹力图引导的止血算法对小儿半球切除术中异体输血需求的影响。回顾性收集2011年1月1日至2023年10月31日在首都医科大学宣武医院接受半球切除术的38例儿童的临床资料。根据是否采用血栓弹力图引导止血算法，将患者分为研究组（n = 17）和对照组（n = 21）。记录人口统计学数据和手术数据。主要结局为异体输血率，包括红细胞输血率、血浆输血率和血小板输血率。次要结局为估计失血量、住院期间术后癫痫发作、血栓栓塞事件和住院时间。研究组有13例男孩和4例女孩，平均年龄为（5.7±3.3）岁；对照组有16例男孩和5例女孩，平均年龄为（7.4±3.4）岁。研究组的手术时长、麻醉时长和氨甲环酸预防性给药比例分别为（424.5±98.5）分钟、（542.8±106.9）分钟和94.1%（16/17），高于对照组的（353.1±85.3）分钟、（445.3±87.9）分钟和47.6%（10/21）（均P<0.05）。研究组术中和围手术期异体血浆输血率分别为52.9%（9/17）和64.7%（11/17），低于对照组的90.5%（19/21）和95.2%（20/21）（均P<0.05）。研究组纤维蛋白原浓缩剂给药比例为58.8%（10/17），高于对照组的4.8%（1/21）（P = 0.001）。两组术中和围手术期异体红细胞输血率无统计学差异（均P>0.05）。两组均未输注血小板。两组间估计失血量、住院期间术后癫痫发作和住院时间无统计学差异（均P>0.05）。未观察到术后血栓栓塞事件。血栓弹力图引导的止血算法可降低小儿半球切除术中异体血浆输血需求，但不能降低红细胞输血需求。
