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目的 在脊柱融合术中常见大量失血。作者以往已证明神经肌肉性脊柱侧凸较特发性脊柱侧凸术中失血更多 ,且输血亦较多。本研究的目的是了解儿童和青少年脊柱侧凸患儿行脊柱融合术时的病因、失血与凝血改变的关系。对象和方法 对大学教学医院的 2 5例接受脊柱融合术的患儿进行前瞻性观察研究 ,11例为神经肌肉性脊柱侧凸 ,14例系特发性脊柱侧凸。分别于术前、术中 2h和 4h、术后2h和 2 4h取血查凝血酶原时间 (PT)、部分凝血活酶时间(PTT)、凝血时间、血小板计数、D 二聚体、VII因子及VIII因子活性、血栓与血栓素III复合物和维生素K缺失诱发蛋白(PIVKA)。采用重复变量分析测量法对不同时间的凝血变化进行分析。组间比较采用独立t检验。结果 神经肌肉性脊柱侧凸患儿较特发性脊柱侧凸患儿出血明显增多 ,血液丢失的中位数分别为全血容量的 78% (2 5 %～ 12 7% )和 2 0 %(2 %～ 82 % ) ,P <0 0 0 1。两组PT随时间延长而增加 ,且神经肌肉性脊柱侧凸组手术前、后均明显高于特发性脊柱侧凸组 (P <0 0 5 )。两组VII因子活性则随时间延长而下降 (P <0 0 0 1) ,且术中神经肌肉组较特发性脊柱侧凸组更低 (P <0 0 5 )。PTT ,TT或VIII因子活性未见改变。术中 4h时两组均出现D 二聚体。所有患儿均未检测到PIVKA。结
Purpose A lot of blood loss is common in spinal fusion. The authors have previously shown that neuromuscular scoliosis has more blood loss and more blood transfusions than idiopathic scoliosis. The purpose of this study was to understand the relationship between etiology, blood loss and coagulation changes in pediatric and adolescent scoliosis undergoing spinal fusion. Subjects and Methods A prospective observational study was performed on 25 children undergoing spinal fusion in university teaching hospitals. Eleven cases were neuromuscular scoliosis and 14 cases were idiopathic scoliosis. The PT, PTT, clotting time, platelet count, D-dimer and factor VII were measured at preoperative, intraoperative 2h and 4h, 2h and 24h after operation respectively. And factor VIII activity, thromboxane III complex and vitamin K deficiency-evoked protein (PIVKA). Analysis of clotting changes at different times using repeated variable analysis and measurement. Comparison between groups using independent t test. Results The children with idiopathic scoliosis had more hemorrhage in children with neuromuscular scoliosis. The median of blood loss were 78% (25% -127%) and 20% 2% ~ 82%), P <0 0 0 1. PT of both groups increased with time, and the neuromuscular scoliosis group was significantly higher than that of idiopathic scoliosis before and after operation (P <0.05). The activity of factor VII in both groups decreased with time (P <0.01), and the neuromuscular group in operation was lower than that in idiopathic scoliosis group (P <0.05). PTT, TT or VIII factor activity was not changed. At 4h, D-dimer appeared in both groups. PIVKA was not detected in all children. Knot