小儿外科重大疾病术前贫血与干预多中心调查

Multi-center epidemiological survey of preoperative anemia and intervention status of some major pediatric surgical diseases

目的 了解国内部分地区小儿外科某些重大疾病术前贫血与干预状况,为进一步开展小儿围术期血液管理提供依据.方法 研究单位分别选择2012年5月至2014年3月期间住院的非紫绀先天性心脏病、先天性巨结肠和胆总管囊肿患儿做回顾性问卷调查.纳入标准：最接近手术日的术前血常规报告血红蛋白（Hb）值低于120 g/L即诊断贫血.干预措施指对术前贫血是否采用输血或补充促红细胞生成素（rHuEPO）、铁剂、维生素等等.结果 共调查北京、上海、杭州、西安、深圳和成都地区6家医院874例患儿.其中先天性心脏病组458例,男282例,女176例;年龄2个月至13.5岁,平均（28.58±29.79）个月.Hb低于120 g/L有276例,总发生率为60.3％,其中轻度贫血（Hb＜120 g/L,≥90 g/L）为58.1％（266/458）,中度以上贫血（Hb＜90 g/L）为2.2％（10/458）.福利院、小于1岁或/和肺动脉高压的患儿贫血发生率分别明显高于总发生率（P=0.008、P＜0.001、P＜0.001）;普外组416例中,男204例,女212例,年龄2个月至16.25岁,平均（28.60±32.30）个月.Hb低于120 g/L有331例,总发生率为79.6％,其中轻度贫血为71.4％（297/416）,中度以上贫血为8.2％（34/416）.术前贫血发生率各个地区存在明显差异,从50％到100％不等;对术前贫血不处理直接手术的比例达到89.1％以上;除个别医院术前采用rHuEPO,较少有其他干预措施.结论 国内部分地区小儿外科某些重大疾病术前贫血发生率较高,不干预直接手术的状况十分普遍,应引起重视.

Objective To explore the incidence of preoperative anemia and intervention status of some major pediatric surgical diseases in some domestic areas so as to provide scientific rationales for perioperative blood management in children.Methods The hospitalized patients with non-cyanotic congenital heart disease,Hirschsprug＇s diseaseor choledochal cyst from May 2012 to March 2014 at all study units were surveyed retrospectively by a standard questionnaire.The preoperative hemoglobin （Hb） of routine blood test report closest to the operation day was collected.Anemia was diagnosed as having a level of Hb under 120 g/L.The intervention measures of anemia referred to blood transfusion or supplemental erythropoietin （rHuEPO）,iron and vitamins,etc.Results A total of 874 patients at six hospitals in Beijing,Shanghai,Hangzhou,Xi＇an,Shenzhen and Chengdu were surveyed.Among congenital heart disease group （n =458）,there were 282 boys and 176 girls with a mean age of 28.58 ±29.79 months.The total incidence rate of anemia was 60.3％ （276/458）,mild anemia 58.1％ （266/458） and moderate anemia 2.2％ （10/458）.The incidence of anemia for children from welfare homes or less than 1 year of age or/and with pulmonary hypertension was significantly higher than that of total incidence rate （P =0.008,P＜0.001-,P＜0.001） ; Among general surgery disease group （n =416）,there were 204 boys and 212 girls with an average age of 28.60 ± 32.30 months.The total incidence rate of anemia was 79.6％ （331/416）,mild anemia 71.4％ （297/416） and moderate anemia 8.2％ （34/416）.The incidence of preoperative anemia differed in each area,ranging from 50％ to 100％.The ratio of direct operation without any intervention measure for preoperative anemia reached over 89.1％.Except for preoperative use of rHuEPO at one hospital,few other interventions were adopted.Conclusions In some domestic areas,the incidence of preoperative anemia is relatively high for some major pediatric surgical diseases.The status of non-intervention for preoperative anemia is quite common.This phenomenon should raise a high alert.