小儿脊柱侧弯手术隐性失血相关因素的调查

Risk factors related to hidden blood loss in pediatric scoliosis surgery

目的通过回顾性调查小儿脊柱侧弯手术的围术期相关资料,初步探讨脊柱手术围术期隐性失血的发生情况、严重程度和相关危险因素等。方法收集中国医学科学院北京协和医院2011年5月—2012年8月269例行小儿脊柱侧弯手术患者的一般资料和围术期相关资料,采用Gross方程计算红细胞容量,进而计算围术期失血量和隐性失血量。结果患儿的总失血量为(1 580±315)mL,显性失血量为(732±197)mL,隐性失血量为(852±206)mL。Pearson相关性分析显示,患儿的围术期总失血量与年龄(r=0.252 9,P<0.000 1)、BMI(r=0.121 0,P=0.047 5)、节段数(r=0.389 0,P<0.000 1)、Cobb角(r=0.405 0,P<0.000 1)、是否截骨(r=0.243 0,P<0.000 1)、手术时间(r=0.511,P<0.001)呈正相关;显性失血量与身高(r=-0.125 5,P=0.039 6)、体重(r=-0.165 8,P=0.006 4)、BMI(r=-0.127 1,P=0.037 2)呈负相关,与节段数(r=0.427 0,P<0.000 1)、Cobb角(r=0.042 8,P<0.000 1)、是否截骨(r=0.215 0,P<0.000 1)、手术时间(r=0.564,P<0.001)呈正相关;隐性失血量与手术时间(r=0.132,P=0.031)呈正相关,与身高(r=-0.197 4,P=0.001 1)、体重(r=-0.266 7,P<0.000 1)、BMI(r=-0.284 5,P<0.000 1)呈负相关。269例手术由8组医师分别完成,不同手术医师实施手术,患儿隐性失血量和隐性失血量占估计血容量比例的差异有统计学意义(P=0.005、0.013)。结论小儿脊柱侧弯手术围术期隐性失血普遍发生,且程度较严重,其相关因素包括身高、体重、BMI、手术时间和手术医师。

Objective To explore the incidence, severity and risk factors of hidden blood loss through a retrospective survey of perioperative data of pediatric scoliosis, Methods Clinical data of 269 pediatric patients with scoliosis treated in Peking Union Medical College Hospital between May 2011 and August 2012 were collected. The red blood cell volume was calculated by the Gross equation and then perioperative blood loss including hidden blood loss was obtained. Results The total blood loss was （1 580±315） mL, including （732±197） mL visible blood loss and （852 ±206） mL hidden blood loss. Pearson correlation analysis showed that the total perioperative blood loss was positively correlated with age （r = 0. 252 9, P〈0. 000 1 ）, body mass index （BMh r=0.121 0, P=0.047 5）, the number of segments （r=0.389 0, P〈0.000 1）, Cobb angle （r=- 0. 405 0, P〈0. 000 1）, bone cutting （ r = 0. 243 0, P〈0. 000 1 ）, and operation time （ r = 0.511, P〈0. 001 ）. Visible blood loss was negatively correlated with height （r = - 0. 125 5, P = 0. 039 6）, weight （r = - 0. 165 8, P = 0. 006 4） and BMI （r = - 0. 127 1, P = 0. 037 2）, and positively correlated with the number of segments （r = 0. 427 0, P〈0. 000 1）, Cobb angle （r = 0. 042 8, P〈0. 000 1）, bone cutting （r = 0.215 0, P〈0. 000 1）, and operation time （r = 0. 564, P〈0. 001）. Hidden blood loss was positively correlated with operation time （r=- 0. 132, P = 0.031 ）, and negatively correlated with height （r = - 0. 197 4, P = 0.001 1）, weight （r = - 0,266 7, P〈0. 000 1）and BMI （r = -0. 284 5, P〈0. 000 1）. All the surgeries were performed by 8 different teams of surgeons. There were significant differences in the volume of hidden blood loss and the ratio of hidden blood loss to estimate blood loss between different teams of surgeons （P = 0. 005, 0. 013）. Conclusion Hidden blood loss iscommon and severe in pediatric scoliosis surgery. Its risk factors include height, weight, BMI, operation time and surgeons.