Kang J K, Lee S W, Baik M W, Son B C, Hong Y K, Jung C K, Ryu K H
Department of Neurosurgery, Kangnam St. Mary's Hospital, Catholic University Medical College, Seoul, Korea.
Childs Nerv Syst. 1998 Jul;14(7):297-301. doi: 10.1007/s003810050230.
Accurate assessment and replacement of blood loss and fluid-electrolyte deficit during craniosynostosis repair is difficult owing to patient size and the diversity of surgical technique. Forty-three patients undergoing primary craniosynostosis repair over a 10-year period were studied retrospectively to determine blood loss and fluid deficit and to assess blood transfusion practices during both intraoperative and postoperative periods. Blood loss was calculated on the basis of estimated red cell mass (ERCM) and fluid-electrolyte imbalance was investigated with blood samplings. Blood transfusion was considered appropriate if the postoperative or posttransfusion ERCM was within 12% of the preoperative value. Estimated fluid requirement (EFR) was used in 4 ml kg(-1) h(-1) except for neonates. Intraoperatively, 80% of all patients were appropriately managed with respect to blood transfusion and EFR. Postoperatively only 20% of the patients receiving transfusions were transfused appropriately. In 23.3% of these patients (10/43) unexpected respiratory distress developed immediately after their recovery from the anesthesia. With the measurement of estimated blood volume and allowable blood loss, appropriate transfusion could be achieved for the successful treatment of the primary craniosynostosis.
由于患者体型和手术技术的多样性，在颅缝早闭修复术中准确评估和补充失血及液体 - 电解质缺乏具有一定难度。对43例在10年期间接受初次颅缝早闭修复术的患者进行回顾性研究，以确定失血量和液体缺乏情况，并评估术中及术后的输血情况。根据估计红细胞量（ERCM）计算失血量，并通过采血调查液体 - 电解质失衡情况。如果术后或输血后的ERCM在术前值的12%以内，则认为输血是合适的。除新生儿外，估计液体需求量（EFR）按4 ml·kg⁻¹·h⁻¹计算。术中，所有患者中有80%在输血和EFR方面得到了适当管理。术后，接受输血的患者中只有20%输血适当。在这些患者中有23.3%（10/43）在从麻醉中苏醒后立即出现意外的呼吸窘迫。通过测量估计血容量和允许失血量，可以实现适当输血，从而成功治疗原发性颅缝早闭。
