术中大量输血对颅内占位患儿检验指标及转归影响分析  

Effect of intraoperative massive blood transfusion on clinical indexes and outcomes for children with intracranial space occupying lesion

作　　者：张慧敏[1] 郭凯 王笑欢 付晓艳 王孟键 张帅行 马曙轩[1] ZHANG Hui-min;GUO Kai;WANG Xiao-huan(Department of Transfusion Medicine,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045)

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,北京100045

出　　处：《临床输血与检验》2022年第5期591-595,共5页Journal of Clinical Transfusion and Laboratory Medicine

摘　　要：目的探讨术中大量输血对颅内占位性病变(space occupying lesion,SOL)患儿临床检验指标及转归的影响。方法选取2021年1月~2021年12月北京儿童医院行开颅占位清除的SOL患儿56例,根据患儿术中红细胞输血量分为大量输血组(n=27)和非大量输血组(n=29),比较两组患儿输血前后相关临床检验指标(血常规、凝血功能、部分生化指标)及转归。结果与输血前相比,非大量输血组患儿输血后凝血酶原时间(PT)延长,钾(K^(+))、钙(Ca^(2+))降低,氯(Cl^(–))、钠(Na^(+))、血糖(GLU)升高(P<0.05);大量输血组患儿输血后血小板(PLT)下降,PT延长,纤维蛋白原(FIB)、K^(+)、Ca^(2+)降低,Cl^(–)、Na^(+)、GLU升高(P<0.05)。和非大量输血组患儿相比,大量输血组ΔPLT、ΔK^(+)、ΔNa^(+)、ΔGLU、ΔFIB变化幅度更大(P<0.05)。同时,大量输血组患儿重症监护室(intensive care unit,ICU)停留时间和住院天数明显延长;住院期间术中大量输血组患儿术后低钾血症发生率74.1%(20/27)、高钠血症发生率22.2%(6/27)和感染率48.1%(13/27)显著高于非大量输血组患儿27.6%(8/29)、3.4%(1/29)和13.8%(4/29)(P<0.05)。结论SOL患儿术中大量输血可能影响凝血功能、生化指标及免疫功能。Objective To explore the effects of intraoperative massive transfusion on laboratory indexes and clinical outcomes for children with the intracranial space-occupying lesion(SOL).Methods A total of 56 children with intracranial SOL were enrollled from January 2021 to December 2021 in the Beijing Children's Hospital.All of them underwent craniotomy for removal of intracranial occupancy.The children were divided into massive transfusion(MT)group(n=27)and non-massive transfusion(NMT)group(n=29)according to intraoperative blood transfusion.The indexes(blood routine,coagulation function,some biochemical indicators)and clinical outcomes were analyzed.Results After transfusion,children in NMT group had prolonged PT,decreased K^(+)and Ca^(2+)concentration,increased Cl^(–)and Na^(+)concentration,and blood glucose after transfusion(P<0.05),while children in MT group had reduced PLT,prolonged PT,decreased FIB,K^(+),and Ca^(2+)concentration,and increased Cl^(–),Na^(+)concentration,and blood glucose(P<0.05).The changes in laboratory indexes before and after transfusion showed thatΔPLT,ΔK^(+),ΔNa^(+),ΔGLU,andΔFIB were more significant in MT group compared with NMT group(P<0.05).Meanwhile,compared to NMT group,intensive care unit(ICU)length of stay and total length of stay were significantly longer in MT group.The incidence of postoperative hypokalemia[74.1%(20/27)vs.27.6%(8/29)],hypernatremia[22.2%(6/27)vs.3.4%(1/29)],and infection[48.1%(13/27)vs.13.8%(4/29)]in MT group was significantly higher than that of NMT group(P<0.05).Conclusion Intraoperative massive transfusion in SOL children may affect the coagulation function,biochemical parameters,and immune function.

关 键 词：患儿 颅内占位 大量输血 实验室指标 临床转归 

分 类 号：R457[医药卫生—治疗学]