71例儿童骨科患者应用自体血回输的回顾性分析

Retrospective analysis of intraoperative salvage autotransfusion in 71 children with orthopedics

目的观察术中自体血回输(ISA)在71例接受骨科手术的儿童患者中的应用,探讨自体血回输在儿童骨科手术患者中的应用效果。方法回顾性分析2018年1月至2018年12月在该院行骨科手术联合使用自体血回输的患儿71例,比较术前和术后1、3、5和7 d血常规、凝血功能、肝肾功能的变化,并进行统计学分析。结果术中平均回输血量为(492.65±202.46)ml。血红蛋白(Hb)、红细胞压积(HCT)和血小板(PLT)在术后1、3 d较术前明显降低(P<0.05),术后5 d开始回升。在术后1 d时,凝血酶原时间(PT)较术前延长(P<0.05),纤维蛋白原(FIB)较术前降低(P<0.05),总胆红素(TB)和直接胆红素(DB)较术前升高(P<0.05),均仍在正常范围内。结论在儿童骨科手术中开展ISA有利于减少围术期异体血的输注,对患儿的凝血功能及肝肾功能没有明显不利影响,但对于大量失血的患儿,术中仍需密切监测凝血功能,及时补充凝血因子等其他血液成分。

【Objective】To observe the application of intraoperative salvage autotransfusion(ISA)in 71 children undergoing orthopedic surgery and to explore the effect of autologous blood transfusion in children undergoing orthopedic surgery.【Methods】From January to December in 2018,71 children underwent orthopedic surgery combined with intraoperative salvage autotransfusion were analyzed retrospectively.The changes of blood routine,coagulation function,hepatic and renal function before and on the 1st,3rd,5th and 7th day after operation were compared and statistically analyzed.【Results】The average blood transfusion volume was(492.65±202.46)ml.Hb,HCT and PLT were significantly lower on the 1st and 3rd day after operation than those before operation(P<0.05),and they began to increase on the 5th day after operation.On the 1st day after operation,prothrombin time(PT)was longer than that before operation,fibrinogen(FIB)was lower than that before operation,total bilirubin(TB)and direct bilirubin(DB)were higher than those before operation,the indexes above were still within the normal range【.Conclusion】ISA is beneficial to reduce the infusion of allogeneic blood during orthopedic surgery in children,and there are no significant adverse effects on the coagulation function and hepatic and renal function of children.However,for children with massive blood loss,it is still necessary to closely monitor the coagulation function and supplement other blood components such as coagulation factors in time.