颅缝早闭症患儿颅骨重塑术围手术期麻醉管理  

Perioperative anesthetic management of pediatric patients with craniosynostosis undergoing cranial vault reconstruction

作　　者：李学斌[1] 王瑶瑶 王娟[1] 曾敏[1] 彭宇明[1] Li Xuebin;Wang Yaoyao;Wang Juan;Zeng Min;Peng Yuming(Department of Anesthesiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100160,China)

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,北京100160

出　　处：《国际麻醉学与复苏杂志》2023年第1期68-73,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的回顾并分析颅缝早闭症患儿颅骨重塑术围手术期管理和并发症,总结此类患儿围手术期麻醉管理要点,提高临床预后质量和安全性。方法回顾收集2016年1月至2021年12月全麻下接受手术治疗的颅缝早闭症患儿的医疗病历记录,分析人口学资料、实验室检查结果、围手术期麻醉管理、术后并发症。结果32例颅缝早闭症患儿被纳入分析,患儿平均年龄为(18±9)个月,男性20例(62.5%),女性12例(37.5%)。术中出血量(44±24)ml/kg,术中Hb最低值(85±21)g/L,21例(65.5%)患儿术中应用了自体血液回收技术,31例(96.9%)患儿接受了异体血输注,23例(71.9%)患儿发生术中低血压,7例(21.9%)患儿出现低血容量性休克,1例(3.1%)患儿因输注血制品发生了过敏性休克,5例(15.6%)患儿苏醒延迟,3例(9.4%)患儿延迟拔管。术后26例(81.3%)患儿出现不同程度的贫血,5例(15.6%)患儿合并凝血障碍,9例(28.1%)患儿在术后接受浓缩红细胞或新鲜冰冻血浆治疗。此外,6例(18.8%)患儿合并电解质紊乱,2例(6.3%)患儿出现低蛋白血症,2例(6.3%)患儿发生肺部感染,1例(3.1%)患儿术后伤口感染,2例(6.3%)患儿出现硬膜下血肿,1例(3.1%)患儿再次手术。结论颅缝早闭症患儿颅骨重塑术围手术期的并发症主要以大量出血、低血压及大量输血造成的凝血障碍为主。综合的血液保护措施、及时的凝血功能监测和积极的围手术期血液管理对于降低输血率,维持围手术期循环稳定,保证手术安全性和质量十分重要。Objective To review and analyze perioperative anesthesia management and complications of child patients with craniostenosis who underwent cranial vault reconstruction,and summarize the key points of perioperative anesthesia management and improve clinical prognosis and safety.Methods The medical records of child patients with craniosynostosis who underwent surgery from January 2016 to December 2021 were retrospectively collected.Their demographic data,laboratory examination results,periopera‑tive anesthetic management and postoperative complications were analyzed.Results A total of 32 children with craniostenosis were analyzed,with the age of(18±9)months.There were 20 boys(62.5%)and 12 girls(37.5%).The mean intraoperative blood loss was(44±24)ml/kg,and the mean intraoperative minimum hemoglobin level was(85±21)g/L.Autologous blood salvage was used in 21 cas‑es(65.5%),while 31 patients(96.9%)were transfused with allogeneic blood products.Furthermore,23 patients(71.9%)experienced in‑traoperative hypotension,and even 7 patients(21.9%)suffered from hypovolemic shock.Anaphylactic shock occurred in 1 patient(3.1%)due to transfusion of blood products,delayed recovery in 5 patients(15.6%),and delayed extubation in 3 patients(9.4%).After surgery,there were 26 cases(81.3%)of anemia to various degree,5 cases(15.6%)of coagulation disorder,and 9 patients(28.1%)were infused with concentrated red blood cells or freshly frozen plasma.Moreover,there were 6 cases(18.8%)of electrolyte disorder,2 cases(6.3%)of pulmonary infection,1 case(3.1%)of postoperative wound infection,2 cases(6.3%)of subdural hematoma,and 1 case(3.1%)of reoperation.Conclusions For child patients with craniostenosis,their perioperative complications after cranial vault reconstruc‑tion are mainly massive bleeding,hypotension,and coagulation disorders due to large volumes of blood transfusion.Comprehensive measures of blood protection,timely coagulation monitoring,and active perioperative management are crucial for reducing blood trans‑fusion rate,ma

关 键 词：颅缝早闭 颅骨重塑手术 围手术期 麻醉管理 并发症 

分 类 号：R726.1[医药卫生—儿科]