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Objective@#This study aims to investigate the correlation of an ultrasonic scoring system with intraoperative blood loss (IBL) in placenta accreta spectrum (PAS) disorders.@*Methods@#A retrospective cohort study was conducted between January 2015 and November 2019. Clinical data for patients with PAS have been obtained from medical records. Generalized additive models were used to explore the nonlinear relationships between ultrasonic scores and IBL. Logistic regressions were used to determine the differences in the risk of IBL ≥ 1,500 mL among groups with different ultrasonic scores.@*Results@#A total of 332 patients participated in the analysis. Generalized additive models showed a significant positive correlation between score and blood loss. The amount of IBL was increased due to the rise in the ultrasonic score. All cases were divided into three groups according to the scores (low score group: ≤ 6 points, @*Conclusions@#The risk of blood loss equal to or greater than 1,500 mL increases further when ultrasonic score greater than or equal to 10 points, the preparation for transfusion and referral mechanism should be considered.
Subject(s)
Adult , Female , Humans , Pregnancy , Blood Loss, Surgical/statistics & numerical data , Gestational Age , Logistic Models , Placenta Accreta/surgery , Predictive Value of Tests , Retrospective Studies , Risk , Ultrasonography, Prenatal/statistics & numerical dataABSTRACT
【Objective】 To explore the influencing factors of perioperative red blood cell transfusion in patients underwent lung transplantation, so as to provide reference for perioperative blood management (PBM) of lung transplantation patients. 【Methods】 The clinical data of 173 lung transplant patients completed in China-Japan Friendship Hospital from March 2017 to June 2019 were retrospectively analyzed. The patients were divided into two groups according to perioperative red blood cell transfusion volume: large blood transfusion group (transfusion red blood cell volume ≥6 U, n=66) and non-large blood transfusion group (red blood cell transfusion volume <6 U, n=107). The basic information, preoperative laboratory test results, and surgical status of the two groups were statistically analyzed.The clinical data of the two groups were analyzed by univariate analysis. The factors of P<0.15 were included in the binary logistic regression analysis, and the independent influencing factors of perioperative massive blood transfusion in patients with lung transplantation were found. 【Results】 Univariate analysis of clinical data of the two groups of patients (large blood transfusion group vs. non-large blood transfusion group) showed that the differences of smoking history ratio [44(66.7%) vs 87(81.3%)], BMI(20.8±4.5 vs 22.5±4.0)(P<0.05), preoperative Hb [124(111, 138.8) vs 138(126, 149)], preoperative Hct [37.9(34.8, 42.5) vs 41.3(37.9, 44.6)], surgery duration(327.9±107.7 vs 238.4±77.0), intraoperative blood loss(1 108.6±1342.0 vs 341.8±270.8) and single lung transplantation [28(42.4%) vs 84(78.5%)] (P<0.01) were statistically significant. Logistic regression analysis showed that intraoperative blood loss (OR=1.001, P<0.05), surgery duration (OR=1.006, P<0.05), preoperative Hb (OR=0.973, P<0.01), lung transplantation type(single or double lung transplantation)( OR=0.247, P<0.05) and extracorporeal membrane oxygenation (ECMO) (OR=0.187, P<0.01) were independent factors influencing red blood cell transfusion during lung transplantation. 【Conclusion】 Intraoperative blood loss and surgery duration are risk factors for massive blood transfusion during the perioperative period. And the use of ECMO, preoperative Hb, single lung transplantation (compared to double lung transplantation) are protective factors for perioperative massive blood transfusion.
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【Objective】 To investigate the effects of tranexamic acid(TXA) on intraoperative blood transfusion(volume) and postoperative coagulation function in patients with partial hepatectomy for hepatic hydatid disease in high altitude area(altitude ≥2 500 m). 【Methods】 Forty-four patients [(39.09±14.70) years old, 19 males and 25 females] underwent elective partial hepatectomy for hydatid after general anesthesia from October 2018 to December 2019 in the Department of Hydatid of Qinghai Provincial People's Hospital, with ASA gradeⅠ~Ⅲ, Child Pugh grade A~B, and normal preoperative coagulation function. They were randomly divided into TXA injection group, who received intravenous injection of TXA 10 mg/(kg·person)(30 min before surgery), and control group, given a placebo needed the equal amounts of injected 0.9% sodium chloride(30 min before surgery). 3 mL of arterial blood was extracted from each patient before intravenous injection and at the end of operation for TEG detection. The intraoperative blood loss and transfusion volume as well as Plt, Hb and TEG parameters before and after surgery were compared between the two groups, and statistical analysis was performed with SPSS22.0 statistical software. 【Results】 The volume of intraoperative blood loss(mL) in TXA group and control group was 300(200, 1 000) vs 1 400(1 000, 2 100), respectively; the units of plasma transfusion(mL) 0(0, 0) vs 380(0, 575); the units of RBC suspension transfusion(mL) 0(0, 400) vs 1 200(800, 600). Preoperative TEG parameters of two groups were similar to each other(P>0.05). The postoperative R, K and Angle(°) of two groups was 8.32±2.24 vs 10.78±2.67, 2.80(2.10, 3.30) vs 3.70(3.20, 4.80) and 54.76±9.48 vs 43.70±9.02, respectively(P<0.05). 【Conclusion】 TXA can significantly improve coagulation functions, as well as effectively reduce intraoperative blood loss and intraoperative blood transfusion in patients with partial hepatic resection of hydatid hepatica in high altitude area.
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Objective: To review the advances in the application of tranexamic acid (TXA) in adolescent spinal corrective surgery. Methods: The mechanism of action and pharmacokinetic, effectiveness, dosage, safety as well as methods of administration were comprehensively summarized by consulting domestic and overseas related literature about the application of TXA in adolescent spinal corrective surgery in recent years. Results: TXA efficaciously reduce intraoperative blood loss, transfusion rate and volume, postoperative drainage volume in adolescent spinal corrective surgery. At present, the most common method of administration in adolescent spinal corrective surgery is that a loading dose is given intravenously before skin incision or induction of anesthesia, followed by a maintenance dose until the end of the surgery. The range of loading dose and maintenance dose is 10-100 mg/kg and 1-10 mg/(kg·h), respectively. No drug related adverse event has been reported in this range. Conclusion: The effectiveness and safety of TXA in adolescent spinal surgery have been basically confirmed. However, further studies are needed to determine the optimal dosage, method of administration as well as whether it could reduce blood loss after surgery.
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Purpose：The purpose of this study was to identify the determinants of walking ability on the first day after total hip arthroplasty (THA).Methods：We conducted a retrospective study of 78 joints that had undergone primary hemilateral side THA. We calculated the percentage of patients who successfully walked on the first day after THA and then performed a multiple logistic regression analysis, with walking condition on the first day after THA as the dependent variable and age, sex, body mass index, preoperative JOA score, intraoperative blood loss, and difference between preoperative and postoperative hemoglobin levels as independent variables.Result：Fifty-eight percent of the subjects started walking on the first day after surgery, with orthostatic hypotension listed as the most common reason for difficulty in walking. The multiple regression analysis revealed that intraoperative blood loss was significantly associated with walking ability on the first day after THA (p＜0.05).Conclusion：Walking ability on the first day after THA was more dependent on intraoperative blood loss than physical characteristics or preoperative hip function. Results of this study suggest that the amount of intraoperative blood loss is an important factor in determining the safety of early mobilization in THA patients.
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Purpose：The purpose of this study was to identify the determinants of walking ability on the first day after total hip arthroplasty (THA).Methods：We conducted a retrospective study of 78 joints that had undergone primary hemilateral side THA. We calculated the percentage of patients who successfully walked on the first day after THA and then performed a multiple logistic regression analysis, with walking condition on the first day after THA as the dependent variable and age, sex, body mass index, preoperative JOA score, intraoperative blood loss, and difference between preoperative and postoperative hemoglobin levels as independent variables.Result：Fifty-eight percent of the subjects started walking on the first day after surgery, with orthostatic hypotension listed as the most common reason for difficulty in walking. The multiple regression analysis revealed that intraoperative blood loss was significantly associated with walking ability on the first day after THA (p＜0.05).Conclusion：Walking ability on the first day after THA was more dependent on intraoperative blood loss than physical characteristics or preoperative hip function. Results of this study suggest that the amount of intraoperative blood loss is an important factor in determining the safety of early mobilization in THA patients.
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Objective To evaluate the possible influence of zoledronic acid on intra-operative bleeding and recurrence of spinal giant cell tumor. Methods A prospective, observational clinical control study was conducted. The zoledronic acid group: patients received zoledronic acid 1 week before (4 mg) and 3 weeks after (4 mg) the surgery; after then 4 mg zoledronic acid was given every 4 weeks for 3 years after surgery or till the patients could not tolerate. The control group: patients received no zoledronic acid or bisphosphonate before and after operation. The intraoperative blood loss was recorded for all the patients and the patients were given an imaging follow-up every 6 months postoperatively to detect recurrence. Results A total of 53 patients were eligible for this study, including 28 for zoledronic acid group and 25 for control group. The average amount of bleeding was (1 594 ± 847) mL (400-3 200 mL) for zoledronic acid group and (2 476 ± 769) mL (800-4 000 mL) for the control group, showing significant difference between the two groups (P<0. 05). No patients in the zoledronic acid group had recurrence or severe adverse reactions within 3 years after surgery. Four patients (16%) in the control group had local recurrence within 3 years after surgery (2 patients occurred after 24 months, 2 patients occurred after 36 months). The Chi-square tests result showed significant difference in recurrence rates between the two groups (x2 =4. 846, P = 0. 028). Conclusion Preoperative use of zoledronic acid can effectively inhibit the bleeding during the operation for spinal giant cell tumor, and long-term postoperative use of zoledronic acid can help to prevent recurrence, which needs large sample study for further verification.
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OBJECTIVE: The purpose of this prospective study was to evaluate the effects of body mass index (BMI) on intra-abdominal pressure (IAP) and intraoperative blood loss (IBL) during lumbar spinal surgery. METHODS: Thirty patients scheduled for single level posterior lumbar interbody fusion were allocated equally to a normal group (Group 1, BMI;18.5-22.9 kg/m2), an overweight group (Group 2, BMI; 23-24.9 kg/m2), and an obese group (Group 3, BMI; 25.0-29.9 kg/m2) according to BMI. IAP was measured using a urinary bladder catheter; 1) supine after anesthesia induction, 2) prone at skin incision, 3) prone at the end of surgery. In addition, IBL was also measured in the three groups. RESULTS: IAP in the supine position was not significantly different in groups 1, 2, and 3 (2.7 mm Hg, 3.0 mm Hg, and 4.2 mm Hg, respectively) (p=0.258), and IAP in the prone position at incision increased to 7.8 mm Hg, 8.2 mm Hg, and 10.4 mm Hg, respectively, in the three groups, and these intergroup differences were significant, especially for Group 3 (p=0.000). IAP at the end of surgery was slightly lower (7.0 mm Hg, 7.7 mm Hg, and 9.2 mm Hg, respectively). IBLs were not significantly different between the three groups. However, IBLs were found to increase with IAP in the prone position (p=0.022) and BMI (p<0.05). CONCLUSION: These results show that BMI affects IAP in the prone position more than in the supine position during lumbar spinal surgery. In addition, IBLs were found to increase with IAP in the prone position and with BMI. Thus, IBLs can be expected to be higher in morbidly obese patients due to an increased IAP.