儿童脑肿瘤切除术中大出血的危险因素分析  

Risk factors of intraoperative massive hemorrhage in children undergoing brain tumor removal

作　　者：张娜[1] 魏伟[1] 许新科 陈程 孙贵芳 谭永红 Zhang Na;Wei Wei;Xu Xinke;Chen Cheng;Sun Guifang;Tan Yonghong(Department of Anaesthesia and Perioperative,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou 510623,China;Cerebral Surgery,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou 510623,China)

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心麻醉与围术期科,广州510623 [2]广州医科大学附属广州市妇女儿童医疗中心颅脑外科,广州510623

出　　处：《国际医药卫生导报》2022年第8期1099-1103,共5页International Medicine and Health Guidance News

基　　金：广州市卫生健康科技项目(20191A011034)。

摘　　要：目的分析儿童脑肿瘤切除术中大出血的危险因素,并探究其对患儿术后恢复的影响。方法回顾性分析2014年10月至2020年12月在广州市妇女儿童医疗中心择期行脑肿瘤切除术290例患儿的临床资料,其中男172例,根据术中失血量(BL)占估计血容量(EBV)的比值(BL/EBV),分为小量出血组(BL/EBV≤0.5)和大量出血组(BL/EBV>0.5),比较患儿相关指标,分析大出血对术后恢复的影响,并对大出血相关因素进行单因素及多因素logistic回归分析,寻找术中大出血的危险因素。计量资料组间比较采用独立样本t检验或Wilcoxon秩和检验,计数资料组间比较采用χ^(2)检验。结果术中大量出血组91例,小量出血组199例,大出血率为31.38%。体质量是术中大出血的保护因素(OR=0.786,P=0.011)、肿瘤最大径是术中大出血的独立危险因素(OR=1.506,P<0.001)。大量出血组术后感染相关并发症发生率显著高于小量出血组,术后机械通气持续时间和术后住院时间也明显延长(均P<0.05)。结论脑肿瘤切除术儿童术前体质量、肿瘤最大径是术中大出血的影响因素,且术中大出血会增加术后并发症的风险。Objective To analyze the risk factors of intraoperative massive hemorrhage in children undergoing brain tumor removal and explore its effect on postoperative recovery.Methods The clinical data of 290 children who underwent elective brain tumor resection in Guangzhou Women and Children's Medical Center from October 2014 to December 2020 were analyzed retrospectively,including 172 males.According to the ratio of intraoperative blood loss to estimated blood volume(BL/EBV),they were divided into a small amount of bleeding group(BL/EBV≤0.5)and a large amount of bleeding group(BL/EBV>0.5).The influence of massive hemorrhage on postoperative recovery was analyzed,and the related factors of massive hemorrhage were analyzed by univariate analysis and multivariate logistic regression analysis.Independent sample t test or Wilcoxon rank-sum test was used for comparison between groups of the measurement data,andχ^(2) test was used for comparison between groups of the count data.Results There were 199 cases in the small amount of bleeding group and 91 cases in the large amount of bleeding group,with a massive hemorrhage rate of 31.38%.Body mass was a protective factor for intraoperative hemorrhage(OR=0.786,P=0.011),and maximum tumor diameter was an independent risk factor for intraoperative hemorrhage(OR=1.506,P<0.001).The incidence of postoperative infection-related complications in the large amount of bleeding group was significantly higher than that in the small amount of bleeding group,and the duration of postoperative mechanical ventilation and postoperative hospital stay were also significantly longer(all P<0.05).Conclusion The preoperative body weight and maximum tumor diameter are influencing factors for intraoperative massive hemorrhage in children undergoing brain tumor resection,and massive hemorrhage will increase the risk of postoperative complications.

关 键 词：儿童 脑肿瘤 出血 影响因素 预后 

分 类 号：R739.41[医药卫生—肿瘤]