PBM血液管理在骶骨神经鞘瘤切除术中的应用

Patient blood management for sacral neurilemmoma resection

目的探讨骶骨神经鞘瘤切除术术中血液管理的方案。方法回顾性分析2012年9月至2016年12月首都医科大学附属北京世纪坛医院12例骶骨神经鞘瘤的血液管理方案,探讨骶骨神经鞘瘤手术血液管理方案在术前准备、术中血压监测、血液丢失及液体输入管理和血管活性药物使用等方面的经验。结果 12例骶骨神经鞘瘤均行囊内刮除,1例患者切除了患者S1神经根,出现足下垂神经功能障碍,其余11例患者均成功从瘤体将神经游离,保留神经,1例患者术后出现脑脊液漏,经过换药及对症治疗治愈,随访平均13个月,神经鞘瘤无复发。术中出血量(1,500±4,670)ml,平均异体输血使用量(1,567±247)ml。通过实施血液管理医疗策略,术中循环维持稳定,所有患者均在术后l小时内停用血管活性药物并拔除气管导管,送返病房。结论血液管理方案包括升红细胞药物及贮存式自身输血是切除骶骨神经鞘瘤减少出血的有效手段。

Objective To investigate the patient blood management for sacral neurilemmoma resection.Methods Retrospectively analyzed the blood administration and surgical procedures during 12 sacral neurilemmoma resection from Beijing Shijitan Hospital Affiliated to Capital Medical University from September 2012 to December 2016,to discuss the preoperative preparation,anesthetic induction and maintainance,intraoperative monitoring and use of vasoactive drugs related experience.Results 12 patients with sacral neurilemmoma were resected with marginal margin.Sacral 1 nerve was not preserved only in 1 patient,foot droop nerve dysfunction occurs.The remaining 11 patients successfully dissociated the nerve from the tumor and preserved the nerve.One patient suffered from cerebrospinal fluid leakage after surgery,and was cured after drug exchange and symptomatic treatment.The average follow-up time was 13 months,and there was no recurrence of schwannoma.Intraoperative blood loss was(15,004±670)ml,mean allogeneic blood transfusion use(1,567±247)ml.Through the implementation of the medical strategy of blood management,the intraoperative circulation remained stable,and all patients stopped taking blood tube active drugs within 1 hour after surgery,and the tracheal tube was removed and sent back to the ward.Conclutions Blood management programs including erythrocyte enhancement drugs and stored autologous transfusion are effective ways to reduce the bleeding of sacral schwannoma.