学龄儿童脊柱侧凸矫形术中自体血回输对节约用血和费用的影响
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摘要
目的探讨学龄儿童脊柱侧凸矫形手术中,自体血回输技术是否可节约用血和医疗费用。方法收集107例行脊柱侧凸矫形手术的7～12岁学龄儿童资料。根据是否采用cell saver 5自体血回输机,分为对照组和自体血回输组(cell saver组)。采用卡钳法进行倾向值匹配后,52例患者的资料匹配成功,观察其围术期各项指标并进行输血相关费用评价。结果与对照组相比,cell saver组的异体红细胞及血浆输注量在术中、术后和整个围术期差异均无统计学意义(均P>0.05);ICU入住时间和术后住院日等其余指标及医疗费用差异也均无统计学意义(均P>0.05)。结论在学龄儿童脊柱侧凸术中,自体血回输不能减少异体红细胞和血浆的需求,也并不经济合算。
Objective To evaluate the efficacy and costs of intraoperative autologous blood transfusion in instrumented posterior correction and fusion surgery for scoliosis in school-aged children. Methods In this single-center, retrospective study 107 school-aged children with scoliosis, who underwent posterior spinal instrumentation and fusion surgery between January 2015 and December 2017, were enrolled. The autologous transfusion was performed intraoperatively with a cell saver in 30 patients(cell saver group) and not performed in 77 patients(control group). The perioperative indexes and the cost of blood transfusion were compared between two groups. Results The propensity score matching produced 26 matched pairs. There were no significant differences in intraoperative, postoperative and perioperative allogeneic RBC(P=0.205, 0.790 and 0.400) and fresh frozen plasma transfusions(P=0.140, 0.844 and 0.328) between cell saver group and control group. There was also no significant difference in the costs between two groups(P=0.235). Conclusion The use of the cell saver will not decrease the amount of allogeneic RBC and fresh frozen plasma transfusion and not reduce the costs of instrumented posterior correction and fusion surgery for scoliosis in school-aged children.
Objective To evaluate the efficacy and costs of intraoperative autologous blood transfusion in instrumented posterior correction and fusion surgery for scoliosis in school-aged children. Methods In this single-center, retrospective study 107 school-aged children with scoliosis, who underwent posterior spinal instrumentation and fusion surgery between January 2015 and December 2017, were enrolled. The autologous transfusion was performed intraoperatively with a cell saver in 30 patients(cell saver group) and not performed in 77 patients(control group). The perioperative indexes and the cost of blood transfusion were compared between two groups. Results The propensity score matching produced 26 matched pairs. There were no significant differences in intraoperative, postoperative and perioperative allogeneic RBC(P=0.205, 0.790 and 0.400) and fresh frozen plasma transfusions(P=0.140, 0.844 and 0.328) between cell saver group and control group. There was also no significant difference in the costs between two groups(P=0.235). Conclusion The use of the cell saver will not decrease the amount of allogeneic RBC and fresh frozen plasma transfusion and not reduce the costs of instrumented posterior correction and fusion surgery for scoliosis in school-aged children.
引文
[1] Zhang H, Guo C, Tang M, et al. Prevalence of scoliosis among primary and middle school students in Mainland China:a systematic review and meta-analysis[J]. Spine(Phila Pa 1976),2015, 40(1):41-49. DOI:10.1097/BRS.0000000000000664.
[2] Bowen RE, Gardner S, Scaduto AA, et al. Efficacy of intraoperative cell salvage systems in pediatric idiopathic scoliosis patients undergoing posterior spinal fusion with segmental spinal instrumentation[J]. Spine(Phila Pa 1976), 2010, 35(2):246-251.DOI:10.1097/BRS.0b013e3181bdf22a.
[3] Ersen O, Ekinci S, Bilgic S, et al. Posterior spinal fusion in adolescent idiopathic scoliosis with or without intraoperative cell salvage system:a retrospective comparison[J]. Musculoskelet Surg, 2012, 96(2):107-110. DOI:10.1007/s12306-012-0203-6.
[4] Akgul A, Dikici F, Ekinci M, et al. The efficacy of cell saver method in the surgical treatment of adolescent idiopathic scoliosis[J].Acta Orthop Traumatol Turc, 2014, 48(3):303-306. DOI:10.3944/AOTT.2014.13.0146.
[5] Weiss LM, Skaggs D, Tanner J, et al. Cell Saver:is it beneficial in scoliosis surgery?[J]. J Child Orthop, 2007, 1(4):221-227. DOI:10.1007/s11832-007-0032-6.
[6] Li L, Greene T. A weighting analogue to pair matching in Dpropensity score analysis[J]. Int J Biostat, 2013, 9(2):215-234. DOI:10.1515/ijb-2012-0030.
[7] Ohrt-Nissen S, Bukhari N, Dragsted C, et al. Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis-a single-center experience of patient blood management in 210cases[J]. Transfusion, 2017, 57(7):1808-1817. DOI:10.1111/trf.14137.
[8] Neslo REJ, Oei W, Janssen MP. Insight into"Calculated Risk":An Application to the Prioritization of Emerging Infectious Diseases for Blood Transfusion Safety[J]. Risk Anal, 2017, 37(9):1783-1795. DOI:10.1111/risa.12752.
[9] Negi G, Gaur DS, Kaur R. Blood transfusion safety:A study of adverse reactions at the blood bank of a tertiary care center[J].Adv Biomed Res, 2015, 4:237. DOI:10.4103/2277-9175. 168604.e Collection 2015.
[10] Owens RK, Crawford CH, Djurasovic M, et al. Predictive factors for the use of autologous cell saver transfusion in lumbar spinal surgery[J]. Spine(Phila Pa 1976), 2013, 38(4):E217-222.DOI:10.1097/BRS.0b013e31827f044e.
[11] Canan CE, Myers JA, Owens RK, et al. Blood salvage produces higher total blood product costs in single-level lumbar spine surgery[J]. Spine(Phila Pa 1976), 2013, 38(8):703-708. DOI:10.1097/BRS.0b013e3182767c8c.
[12] Liang J, Shen J, Chua S, et al. Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study[J]. Eur Spine J, 2015, 24(2):270-275. DOI:10.1007/s00586-014-3282-2.
[13] Stone N, Sardana V, Missiuna P. Indications and Outcomes of Cell Saver in Adolescent Scoliosis Correction Surgery:A Sy stematic Review[J]. Spine(Phila Pa 1976), 2017, 42(6):E363-E370. DOI:10.1097/BRS.0000000000001780.
[14]许华晔,孙玉娥,崔士和,等.术中自体血回输在儿童脊柱侧凸后路矫形手术中的应用[J].现代医学, 2016, 44(6):801-804.
[2] Bowen RE, Gardner S, Scaduto AA, et al. Efficacy of intraoperative cell salvage systems in pediatric idiopathic scoliosis patients undergoing posterior spinal fusion with segmental spinal instrumentation[J]. Spine(Phila Pa 1976), 2010, 35(2):246-251.DOI:10.1097/BRS.0b013e3181bdf22a.
[3] Ersen O, Ekinci S, Bilgic S, et al. Posterior spinal fusion in adolescent idiopathic scoliosis with or without intraoperative cell salvage system:a retrospective comparison[J]. Musculoskelet Surg, 2012, 96(2):107-110. DOI:10.1007/s12306-012-0203-6.
[4] Akgul A, Dikici F, Ekinci M, et al. The efficacy of cell saver method in the surgical treatment of adolescent idiopathic scoliosis[J].Acta Orthop Traumatol Turc, 2014, 48(3):303-306. DOI:10.3944/AOTT.2014.13.0146.
[5] Weiss LM, Skaggs D, Tanner J, et al. Cell Saver:is it beneficial in scoliosis surgery?[J]. J Child Orthop, 2007, 1(4):221-227. DOI:10.1007/s11832-007-0032-6.
[6] Li L, Greene T. A weighting analogue to pair matching in Dpropensity score analysis[J]. Int J Biostat, 2013, 9(2):215-234. DOI:10.1515/ijb-2012-0030.
[7] Ohrt-Nissen S, Bukhari N, Dragsted C, et al. Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis-a single-center experience of patient blood management in 210cases[J]. Transfusion, 2017, 57(7):1808-1817. DOI:10.1111/trf.14137.
[8] Neslo REJ, Oei W, Janssen MP. Insight into"Calculated Risk":An Application to the Prioritization of Emerging Infectious Diseases for Blood Transfusion Safety[J]. Risk Anal, 2017, 37(9):1783-1795. DOI:10.1111/risa.12752.
[9] Negi G, Gaur DS, Kaur R. Blood transfusion safety:A study of adverse reactions at the blood bank of a tertiary care center[J].Adv Biomed Res, 2015, 4:237. DOI:10.4103/2277-9175. 168604.e Collection 2015.
[10] Owens RK, Crawford CH, Djurasovic M, et al. Predictive factors for the use of autologous cell saver transfusion in lumbar spinal surgery[J]. Spine(Phila Pa 1976), 2013, 38(4):E217-222.DOI:10.1097/BRS.0b013e31827f044e.
[11] Canan CE, Myers JA, Owens RK, et al. Blood salvage produces higher total blood product costs in single-level lumbar spine surgery[J]. Spine(Phila Pa 1976), 2013, 38(8):703-708. DOI:10.1097/BRS.0b013e3182767c8c.
[12] Liang J, Shen J, Chua S, et al. Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study[J]. Eur Spine J, 2015, 24(2):270-275. DOI:10.1007/s00586-014-3282-2.
[13] Stone N, Sardana V, Missiuna P. Indications and Outcomes of Cell Saver in Adolescent Scoliosis Correction Surgery:A Sy stematic Review[J]. Spine(Phila Pa 1976), 2017, 42(6):E363-E370. DOI:10.1097/BRS.0000000000001780.
[14]许华晔,孙玉娥,崔士和,等.术中自体血回输在儿童脊柱侧凸后路矫形手术中的应用[J].现代医学, 2016, 44(6):801-804.