Blood Loss and Transfusion in a Pediatric Scoliosis Surgery Cohort in the Antifibrinolytic Era.
Blood Loss and Transfusion in a Pediatric Scoliosis Surgery Cohort in the Antifibrinolytic Era.
复制标题
抗纤溶时代小儿脊柱侧凸手术队列的失血和输血。
DOI：
10.1097/mph.0000000000002351
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发表时间：
2022-04-01
期刊：
影响因子：
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通讯作者：
Borst AJ
中科院分区：
文献类型：
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作者：
Ahlers CG;Lan M;Schoenecker JG;Borst AJ
接受脊柱侧凸后路脊柱融合术的儿童和青少年经历了高出血率和血液制品输注。抗纤溶治疗是减少小儿脊柱侧凸手术中失血和输血的关键策略之一。在这里，我们回顾了2017年至2018年在我们机构接受后路脊柱融合术的172例儿童脊柱侧凸患者（出生至21岁）。我们报告了失血和输血的发生率，比较了接受氨甲环酸（TXA）和ε-氨基己酸（EACA）的患者，并评价了抗纤溶药物和实验室参数作为失血和输血的预测因素。术中，62%接受了TXA，38%接受了EACA。总的来说，失血（平均术中估计失血量= 14.9 ± 9.7 mL/kg，22%具有临床显著失血量（> 20 mL/kg），平均计算Hgb质量损失= 175.9 ± 70.1 g）和输血率（15%，术中输注同种异体红细胞[RBC]，平均术中同种异体RBC输注量= 12.5 ± 7.1 mL/kg）与先前研究术中抗纤溶药物的队列相似。抗纤溶组之间的术中估计失血量、临床显著失血量、计算的血红蛋白质量损失或输血率无差异。抗纤溶药物的选择不能预测失血或输血。常规血液学实验室参数和抗纤溶药物的选择不足以预测失血量或其他结局。未来基于实验室的前瞻性研究可能会提供一个更全面的模型，脊柱侧凸手术中的药物诱导的凝血功能障碍，并提供一个更好的工具，预测失血量和改善结果。
Children and adolescents undergoing posterior spinal fusion for scoliosis experience high rates of bleeding and blood product transfusion. Antifibrinolytic therapy is one key strategy to decrease blood loss and transfusion in pediatric scoliosis surgery. Here we review 172 pediatric scoliosis patients (birth to 21 years) who underwent posterior spinal fusion at our institution from 2017 to 2018. We reported rates of blood loss and transfusion, compared patients receiving tranexamic acid (TXA) to a ε-aminocaproic acid (EACA), and evaluated antifibrinolytic agent and laboratory parameters as predictors of blood loss and transfusion. Intraoperatively, 62% received TXA and 38% received EACA. Overall, blood loss (mean intraoperative estimated blood loss = 14.9 ± 9.7 mL/kg, 22% with clinically significant blood loss (> 20mL/kg), and mean calculated Hgb mass loss = 175.9 ± 70.1 g) and transfusion rates (15% with intraoperative allogeneic red blood cell [RBC] transfusion and mean intraoperative allogeneic RBC transfusion volume = 12.5 ± 7.1 mL/kg) were similar to previous cohorts studying intraoperative antifibrinolytics. There was no difference in intraoperative estimated blood loss, clinically significant blood loss, calculated hemoglobin mass loss, or transfusion rates between the antifibrinolytic groups. Antifibrinolytic choice was not predictive of blood loss or transfusion. Routine hematologic laboratory parameters and antifibrinolytic choice were insufficient to predict blood loss or other outcomes. Future prospective laboratory-based studies may provide a more comprehensive model of surgical-induced coagulopathy in scoliosis surgery and provide a better tool for predicting blood loss and improving outcomes.