23例RhD阴性患儿行神经外科手术围术期血液管理分析  

Analysis of perioperative blood management in 23 RhD-negative children undergoing neurosurgery

作　　者：王琦[1] 梁辉[1] 陆瑜[1] 韩如泉[1] Wang Qi;Liang Hui;Lu Yu;Han Ruquan(Department of Anesthesiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,北京100070

出　　处：《首都医科大学学报》2024年第5期907-911,共5页Journal of Capital Medical University

摘　　要：目的分析RhD阴性患儿行神经外科手术围术期血液管理的特点以提高临床预后和安全性。方法回顾性收集2015至2022年接受颅内占位切除的RhD阴性患儿的病历记录,分析人口学资料、实验室检测结果、备血及输血相关围术期血液管理。结果23例RhD阴性患儿被纳入分析,患儿平均年龄(7±3.5)岁,术前22例(95.7%)申请备异体血,17例(73.9%)备血成功,5例(21.7%)术前备血未成功,从申请备血到手术的平均时间为(5.8±3)d,备异体红细胞260(260,455)mL,1例(4.3%)患儿术前储存自体全血400 mL;术中出血4.8(2.2,13.3)mL/kg,总计10例进行了输血,其中7例(30.4%)仅输入异体红细胞,1例(4.3%)输入异体红细胞及自体回收红细胞,1(4.3%)例输入自体回收红细胞,1例(4.3%)输入储存全血150 mL,输血率为43.5%,配血输注比(cross-match/transfused,C/T值)=2.7,输血指数(transfusion index,Ti)=1。术中12例(52.2%)患儿行动脉血气分析,2例(8.7%)患儿监测血栓弹力图,术后血红蛋白(117±19.4)g/L,6例(26.1%)患儿术后出现轻度贫血,2例(8.7%)中度贫血。结论RhD阴性患儿行神经外科手术备血困难,需根据病变类型及部位针对性制定围术期血液管理方案,并采用多模式治疗策略以减少出血及对异体RhD阴性血的依赖,保障患儿手术安全。Objective Retrospective analysis of perioperative blood management in RhD-negative children undergoing neurosurgery,and analysis of the characteristics of management of such children to improve clinical prognosis and safety.Methods We retrospectively collected the medical records of RhD-negative children who underwent intracranial occupancy resection from 2015 to 2022 and analyzed demographic information,laboratory test results,blood preparation and transfusion-related perioperative blood management.Results Twenty-three RhD-negative children were included in the analysis.The average age of the children was(7±3.5)years old,preoperative preparation of allogeneic blood was requested in 22 cases(95.7%),17 cases(73.9%)were successful and 5 cases(21.7%)were unsuccessful in preoperative blood preparation,the time between requesting blood preparation and surgery was(5.8±3)d,and 260(260,455)mL of allogeneic red blood cells were prepared,of which 1 case(4.3%)had 400 mL of preoperative autologous stored whole blood.Intraoperative bleeding was 4.8(2.2,13.3)mL/kg.Of the 10 blood transfusions,7(30.4%)were transfused with allogeneic red blood cells only,1(4.3%)was transfused with allogeneic red blood cells and autologous red blood cells,1(4.3%)was transfused with autologous red blood cells,and 1 case(4.3%)was transfused with 150 mL of stored whole blood.The transfusion rate was 43.5%,with the crossmatch to transfusion(C/T)ratio of 2.7,and transfusion index(Ti)of 1.Intraoperative arterial blood gas analysis was performed in 12(52.2%)cases,thromboelastography was monitored in 2(8.7%)cases.Postoperative hemoglobin was(117±19.4)g/L.Mild anemia was observed in 6(26.1%)cases,and moderate anemia was observed in 2(8.7%)cases after surgery.Conclusions It is necessary to formulate a blood transfusion plan and reasonable perioperative blood management according to the type and location of the child s lesion and adopt a multimodal treatment strategy to reduce bleeding and the dependence on allogeneic RhD-negative blood to ensure the saf

关 键 词：RHD阴性 小儿神外手术 围术期血液管理 

分 类 号：R457.1[医药卫生—治疗学]