Evran Turan, Egemen Emrah, Albuz Barış, Çopur İsmet, Asar Rasim, Yıldız Aslı Mete, İlhan Seher, Civlan Serkan, Sungurtekin Hülya
Department of Anesthesiology and Reanimation, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey.
Department of Neurosurgery, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey.
Medicina (Kaunas). 2025 Mar 28;61(4):618. doi: 10.3390/medicina61040618.
: This study aims to evaluate the adequacy of the liberal transfusion strategy applied in patients undergoing endoscopy-assisted Metopic, Coronal, or Sagittal craniosynostosis surgery according to the Pre-Transfusion and Post-Transfusion Estimated Red Blood Cell Mass (ERCM) ratios. : This retrospective cohort study, conducted at the Pamukkale University Faculty of Medicine (2017-2023), utilized anesthesia, surgical records, and hospital electronic data of patients undergoing endoscopic craniosynostosis surgery. The primary endpoints were the rates of Post-Transfusion 1st-hour ERCM/Pre-Transfusion ERCM (%) and Post-Transfusion 24th-hour ERCM/Pre-Transfusion ERCM (%). The secondary endpoints were determined as Hemoglobin (Hb) and Hematocrit (Hct) values at the 1st and 24th hours after surgery, Calculated Blood Loss (CBL) during surgery (%), total 24 h CBL (%), ERCM (%), and Estimated Blood Loss (EBV) during surgery and total 24 h transfusions, Packed Red Blood Cells (PRBCs) (mL/kg) amounts during surgery, and total 24 h transfusions. : A total of 86 pediatric craniosynostosis cases were evaluated and categorized into Metopic ( = 38), Sagittal ( = 33), and Coronal ( = 15) groups, with Post-Transfusion evaluation conducted across these groups. Post-Transfusion 1st-hour ERCM/Pre-Transfusion ERCM ratios were found to have median values of 90.70% in the Metopic group, 91.61% in the Sagittal group, and 93.09% in the Coronal group. Post-Transfusion 24th-hour ERCM/Pre-Transfusion ERCM ratios were found to be median values of 94.05% in the Metopic group, 88.3% in the Sagittal group, and 87.08% in the Coronal group. : The liberal transfusion strategy provided adequate transfusion, maintaining ERCM ratios within the 85-115% range across all groups. Significant decreases in Hb and Hct levels were observed from preoperative to postoperative measurements at 1 and 24 h. Changes in CBL, ERCM, EBV, and PRBC volumes were noted between the postoperative 1 h and 24 h measurements across all groups.
本研究旨在根据输血前和输血后估计红细胞量（ERCM）的比率，评估在内镜辅助下进行额缝、冠状缝或矢状缝早闭手术的患者中应用宽松输血策略的充分性。本回顾性队列研究在帕穆克卡莱大学医学院开展（2017 - 2023年），利用了接受内镜下颅缝早闭手术患者的麻醉、手术记录及医院电子数据。主要终点是输血后第1小时的ERCM/输血前ERCM（%）和输血后第24小时的ERCM/输血前ERCM（%）。次要终点确定为术后第1小时和第24小时的血红蛋白（Hb）和血细胞比容（Hct）值、手术期间的计算失血量（CBL）（%）、24小时总CBL（%）、ERCM（%）、手术期间及24小时总输血的估计失血量（EBV）、手术期间的浓缩红细胞（PRBC）（mL/kg）量以及24小时总输血量。共评估了86例小儿颅缝早闭病例，并将其分为额缝组（n = 38）、矢状缝组（n = 33）和冠状缝组（n = 15），对这些组进行输血后评估。发现输血后第1小时的ERCM/输血前ERCM比率在额缝组的中位数为90.70%，矢状缝组为91.61%，冠状缝组为93.09%。输血后第24小时的ERCM/输血前ERCM比率在额缝组的中位数为94.05%，矢状缝组为88.3%，冠状缝组为87.08%。宽松输血策略提供了充分的输血，使所有组的ERCM比率维持在85 - 115%的范围内。从术前到术后1小时和24小时的测量中，观察到Hb和Hct水平显著下降。在所有组中，术后1小时和24小时的测量之间，CBL、ERCM、EBV和PRBC体积发生了变化。
