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| 自体血回输在脊柱侧弯矫形术中的应用 |
| Application of cell saver use in instrumented posterior correction and fusion surgery for scoliosis |
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| DOI：10.12089/jca.2021.11.005 |
| 中文关键词: 自体血回输 同源异体血 脊柱侧弯 倾向评分匹配 凝血功能 |
| 英文关键词: Cell saver Allogeneic red blood cell Idiopathic scoliosis Propensity score matching Coagulation |
| 基金项目: |
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| 摘要点击次数: 2042 |
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| 中文摘要: |
目的 了解脊柱侧弯矫形术中使用自体血回输装置（CS）是否减少术中及围术期对同源异体血的需求。
方法 选择2013年7月至2017年5月期间行脊柱侧弯矫形术的患者436例，男123例，女313例，年龄10～18岁，BMI 14 ～ 25 kg/m 2，ASA Ⅰ或Ⅱ级。设术中出血量为检验的唯一变量，采用倾向评分匹配后分为两组：使用自体血组（CS组）和未使用自体血组（NCS组），每组67例。两组患者均采用全身麻醉，CS组使用自体血，NCS组未使用自体血。比较两组患者术中出血量、术后总引流量、手术融合节段数、手术时间。比较术前1 d、术后1 d和出院前的凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）和纤维蛋白原（FIB），术中和术后异体红细胞输注量，总异体红细胞输注量，新鲜冰冻血浆输注量，术中异体红细胞输注率，围术期总异体红细胞输注率，术前1 d、出院前的血红蛋白（Hb）和红细胞比容（Hct），围术期电解质紊乱、急性肾功能损伤、肺部感染、伤口感染等手术或麻醉相关不良反应发生情况。
结果 CS组术中融合节段数明显多于NCS组（P<0.05），术后总引流量明显高于NCS组（P<0.05）。与术前1 d比较，术后1 d和出院前两组PT明显延长（P<0.05），出院前两组FIB明显升高（P<0.05），不同时点两组APTT差异无统计学意义。CS组术中异体红细胞输注量、输注率明显低于NCS组（P<0.05）。两组术后异体红细胞输注量、总异体红细胞输注量、新鲜冰冻血浆输注量、围术期总异体红细胞输注率差异无统计学意义。两组不同时点Hb、Hct差异无统计学意义。两组围术期均未见电解质紊乱、急性肾功能损伤、肺部感染、伤口感染等手术或麻醉相关不良反应发生。
结论 10～18岁患者行脊柱侧弯术使用自体血回输装置可以有效降低术中异体红细胞的需求，但未能减少围术期总异体红细胞的输注量及输注率。 |
| 英文摘要: |
Objective To investigate the effect and safety of routine cell saver use in idiopathic scoliosis patients undergoing primary posterior spinal fusion surgery with segmental spinal instrumentation.
Methods A total of 436 patients scheduled for posterior spinal instrumentation and fusion surgery under general anesthesia, including 123 males and 323 females, aged 10-18 years, BMI 14-25 kg/m 2, ASA physical status Ⅰ or Ⅱ, were selected from July 2013 and May 2017. Intraoperative amount of bleeding was set as the only variable for the test, and the propensity score matching (PSM) produced 67 matched pairs, divided into the group CS that were used cell saver (n = 67) and the group NCS that weren't used cell saver (n = 67). Cases in both groups underwent general anesthesia. Intraoperative blood loss, total drainage after surgery, number of surgical fusion segments, time for surgery, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) at 1 day before operation, first day after operation and last time before discharge, intraoperative fluid transfusion, allogeneic blood transfusion during intraoperative and postoperative, total allogeneic blood transfusion, fresh frozen plasma transfusion, blood transfusion rate during intraoperative and perioperative, hemoglobin (Hb) , hematocrit (Hct) 1 day before operation and last time before operation, the surgery or anesthesia adverse reactions of electrolyte disorders, acute renal impairment, lung infections, wound infections during perioperative, et, were compared between the two groups.
Results The number of intraoperative fusion segments in group CS were significantly more than that in group NCS (P < 0.05), total drainage after surgery were significantly more than that in group NCS (P < 0.05). Two groups of PT of the first day after operation and two groups of PT before discharge were significantly higher, compared with the 1 day before operation (P < 0.05). Two groups of FIB before discharge were significantly higher, compared with the 1 day before operation (P < 0.05). There were no significant differences in APTT between the two groups at different time points. In group CS, allogeneic blood transfusion and transfusion rate during intraoperative were significantly lower than those in group NCS (P < 0.05). There were no significant differences in allogeneic blood transfusion during postoperative, total allogeneic blood transfusion, fresh frozen plasma transfusion and blood transfusion rate during perioperation. There were no significant differences in Hb and Hct at different time points in both groups. There were no electrolyte disorders, acute renal impairment, lung infections, and wound infections in both groups.
Conclusion Patients aged 10 to 18 years old can effectively reduce the need for allogeneic blood transfusion during intraoperative by using CS, but failed to decrease total perioperative allogeneic blood transfusion or transfusion rate. |
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