儿童先天性脊柱侧弯后路截骨矫形术围手术期出血的相关因素分析  

Predictors for perioperative blood loss in pediatric patients with congenital scoliosis

作　　者：刘昊楠 张学军[1] 李嘉鑫 郭东[1] 白云松[1] 姚子明 范竟一[1] Liu Haonan;Zhang Xuejun;Li Jiaxin;Guo Dong;Bai Yunsong;Yao Ziming;Fan Jingyi(Department of Orthopedics,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院骨科,北京100045

出　　处：《中华医学杂志》2020年第25期1962-1966,共5页National Medical Journal of China

摘　　要：目的探讨儿童先天性脊柱侧弯患儿行后路截骨矫形内固术的围手术期出血情况并分析其相关的影响因素。方法将2017年6月至2019年6月于北京儿童医院接受手术治疗的106例先天性脊柱侧弯患儿纳入研究,所有患儿均行后路单节段截骨矫形内固定术。术前根据身高、体重计算患儿的总血容量。住院期间记录患儿围手术期显性失血,术后根据OSTHEO公式计算患儿隐性失血。将患儿年龄、性别、身高、体重、术前Cobb角、矢状面后凸角、矫正的Cobb角及后凸角、手术节段、置钉数量、手术时间、实验室检查等指标纳入多元线性回归方程,探讨影响围手术期出血的相关因素。结果所有患儿均顺利完成手术。患儿年龄(7.3±2.3)岁,手术时间(162±56)min,平均3个手术节段,手术矫正率78.4%。患儿围手术期失血总计(568±208)ml,占总体血容量的42.3%,其中显性失血(334±193)ml,隐性失血(234±199)ml,分别占总体失血量的58.8%和41.2%。多元回归分析显示,年龄、术前Cobb角、手术时间、手术节段数与围手术期出血量密切相关。术前Cobb角≥40°、手术范围≥4个节段、手术时间≥140 min的患儿出血量明显增加(均P<0.05)。性别、后凸角度、矫正的角度、置钉数量、术前血常规、凝血等指标与围手术期出血无明显相关性。结论先天性脊柱侧弯患儿围术期出血量多,其中隐性失血的比例较高;畸形严重、手术节段多、手术时间长的患儿发生大量失血的风险较高。Objective To identify predictors of massive blood loss after posterior hemivertebra resection for patients with congenital scoliosis.Methods The data of 106 children with congenital scoliosis were collected from June 2017 to June 2019 in Beijing Children′s Hospital.All the cases received posterior hemivertebra resection and internal fixation.The blood volume was estimated by weight and height.The visible blood loss was recorded according to medical record,and the hidden blood loss was calculated by OSTHEO formula.Perioperative information including age,gender,height,weight,Cobb and kyphosis angle,level fused,number of screws,operative time,and laboratory examinations was collected.Then multivariable linear regression was performed to determine the independent risk factors of blood loss.Results All the surgeries were completed successfully.The mean age of the children was(7.3±2.3)years and the operative time was(162±56)min.The mean fused levels were 3 and the correction rate for deformity was 78.4%.The amount of blood loss was(568±208)ml which accounted for 42.3%of total blood volume.The visible and hidden blood loss was(334±193)ml and(234±199)ml,respectively,and which accounted for 58.8%and 41.2%of total blood loss.Multivariable linear regression analysis indicated that age,preoperative Cobb angle,the time of surgery and the number of fused levels were independent risk factors of total blood loss.Preoperative Cobb angle≥40°,spinal fusion≥4 levels and operative duration≥140 min indicated more blood loss(all P<0.05).Conclusions The perioperative blood loss of congenital scoliosis is massive with a high percentage of hidden blood loss.The patients with severe deformity,more fused levels and increased operative time brings higher risk of massive blood loss.

关 键 词：脊柱侧凸 先天性脊柱侧弯 脊柱矫形 失血 手术 

分 类 号：R726.8[医药卫生—儿科]