Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector152910.17816/psaic1529Original Study ArticlesОригинальные исследованияResearch ArticlePerioperative use of erythrocyte-containing blood components in children during the first months of lifeПериоперационное применение эритроцитсодержащих компонентов крови у детей первых месяцев жизни含红细胞血液成分在出生后最初几个月的儿童围手术期的应用https://orcid.org/0000-0001-5217-46414965-6597MezhevikinaValentina M.МежевикинаВалентина МихайловнаMezhevikinaValentina M.
Russian Federation
mezhevikina.valentina@gmail.comhttps://orcid.org/0000-0001-7861-67785560-6679ZhirkovaYulia V.ЖирковаЮлия ВикторовнаZhirkovaYulia V.
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

MD, Dr. Sci. (Medicine), Professor

zhirkova@mail.ruhttps://orcid.org/0000-0001-8417-35554414-0677LazarevVladimir V.ЛазаревВладимир ВикторовичLazarevVladimir V.
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

MD, Dr. Sci. (Medicine), Professor

examlpe@address.ruPirogov Russian National Research Medical UniversityРоссийский национальный исследовательский медицинский университет им. Н.И. ПироговаPirogov Russian National Research Medical UniversitySperansky Children’s Hospital No. 9Детская городская клиническая больница № 9 им. Г.Н. СперанскогоSperansky Children’s Hospital No. 9160720241421952051306202323042024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-ВекторCopyright ©; 2024,2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/1529

BACKGROUND: Anemia can be diagnosed before surgery, occur during surgical treatment, and develop and worsen in the postoperative period in children with surgical diseases. Anemia is associated with increased morbidity, severe complications, and even death after surgical treatment.

AIM: This study aimed to determine the frequency and indications for transfusion of red blood cell-containing components in the perioperative period in children in the first months of life.

MATERIALS AND METHODS: This cohort study included 187 children from the G.N. Speransky Children’s Hospital No. 9. The hemoglobin, hematocrit, and red blood cell levels were studied as well as the volume of intraoperative blood loss, hemodynamic parameters, the presence of hemorrhagic syndrome, and the use of adrenomimetics in the perioperative period. The stage of the perioperative (pre, intra, or post) period at which the transfusion of erythrocyte-containing components was conducted was recorded. Statistical data analysis was performed using the statistical computing environment R 4.3.0.

RESULTS: The average age of the children at the time of surgery was 41 (16.5–63) days [5.9 (2.4–9) weeks]. Sixty-four (34.2%) children were in their first month of life, 72 (38.5%) in their second month, and 51 (27.3%) in their third month, and 76 (40.6%) children were premature. The surgeries were emergent and urgent in 102 (54.5%) children and planned in 85 (45.5). The hemoglobin, hematocrit, and erythrocyte levels at which erythrocyte-containing components were transfused were 82 (77–90) g/l, 25% (22%–28%), and 2.8 (2.3–3.0) × 1012/l, respectively. The volume of erythrocyte-containing components was 54.0 (32.9–74.4) ml (10–30 ml/kg/child’s body weight). The need for and duration of artificial pulmonary ventilation in the postoperative period were 31 (72.1%) cases and 48.5 (22.5–190) hours, respectively, in contrast to children who did not receive transfusions of red blood cell-containing components—57 (39.6%) cases and 40 (22–96) hours. The indication for transfusion was anemia of varying degrees; however, 74.4% of children received adrenergic agonists simultaneously with transfusion to stabilize hemodynamics: dopamine monotherapy in 23 (74.2%) and combinations of dopamine and norepinephrine in 8 (25.8%) at 10 (8–12) mcg/kg/min and 0.2 (0.15–0.4) mcg/kg/min, respectively.

CONCLUSION: The frequency of use of red blood cell-containing components was 23%. Threshold values for transfusion of erythrocyte-containing components Hb, Ht, and erythrocytes were 82 (77–90) g/l, 25% (22%–28%), and 2.8 (2.3–3.0) × 1012/l, respectively.

Актуальность. У детей с хирургическими заболеваниями анемия может диагностироваться до операции, возникнуть во время хирургического лечения, а также развиваться и усугубляться в послеоперационном периоде. Анемия ассоциируется с повышенной заболеваемостью, развитием тяжелых осложнений и даже смертельными исходами после оперативного лечения.

Цель — определить частоту и показания для переливания эритроцитсодержащих компонентов в периоперационном периоде у детей первых месяцев жизни.

Материалы и методы. В когортное исследование на базе Детской городской клинической больницы № 9 им. Г.Н. Сперанского включено 187 детей. Изучали уровень гемоглобина, гематокрита и эритроцитов, проводили оценку объема интраоперационной кровопотери, фиксировали показатели гемодинамики, наличие геморрагического синдрома, применение адреномиметиков в периоперационном периоде. Фиксировали, на каком из этапов периоперационного (до, интра или после) периода проводили трансфузию эритроцитсодержащих компонентов. Статистический анализ данных проводили с использованием среды для статистических вычислений R 4.3.0.

Результаты. Возраст детей на момент операции составил 41 (16,5–63) день [5,9 (2,4–9) нед.]. Из них 64 (34,2 %) ребенка первого месяца жизни, 72 (38,5 %) — второго и 51 (27,3 %) — третьего. Недоношенными были 76 (40,6 %) детей. У 102 (54,5 %) детей операции носили экстренный и срочный характер, а у 85 (45,5 %) — плановый. Уровень гемоглобина, гематокрита и эритроцитов, при котором переливали эритроцитсодержащие компоненты, составил соответственно 82 (77–90) г/л, 25 (22–28) % и 2,8 (2,3–3,0) × 1012/л. Объем эритроцитсодержащих компонентов составил 54,0 (32,9–74,4) мл (10–30 мл на килограмм массы тела ребенка). Потребность и длительность искусственной вентиляции легких в послеоперационном периоде составили соответственно 31 (72,1 %) случай и 48,5 (22,5–190) ч, в отличие от детей, которым не проводилось переливание эритроцитсодержащих компонентов — 57 (39,6 %) случаев и 40 (22–96) ч. Показанием для проведения трансфузии служила анемия разной степени, однако следует отметить, что 74,4 % детей одновременно с трансфузией для стабилизации гемодинамики получали адреномиметики: монотерапия допомином — у 23 (74,2 %) пациентов, сочетания препаратов допамин и норадреналин — у 8 (25,8 %); дозировки препаратов 10 (8–12) мкгр/(кг × мин) и 0,2 (0,15–0,4) мкгр/(кг × мин) соответственно.

Заключение. Частота использования эритроцитсодержащих компонентов составила 23 %. Пороговые значения для переливания эритроцитсодержащих компонентов: гемоглобин 82 (77–90) г/л, гематокрит 25 (22–28) %, эритроциты 2,8 (2,3–3,0) × 1012/л.

现实意义。对于患有外科疾病的儿童，贫血可以在术前被诊断出来，也可能在手术治疗过程中发生，还可能在术后发展和恶化。贫血与手术治疗后发病率增加、严重并发症甚至死亡有关。 目的旨在确定出生后最初几个月的儿童在围手术期输注含红细胞成分的频率和适应症。

材料与方法。一项基于Speransky Children’s City Clinical Hospital No. 9的队列研究，包括187名儿童。研究了血红蛋白、血细胞比容和红细胞水平，评估了术中失血量，记录了血液动力学指标、出血性综合征以及围手术期使用肾上腺激素的情况。我们记录了在围手术期的哪个阶段（术前、术中或术后）进行了含红细胞成分的输血。我们使用R 4.3.0统计计算环境对数据进行了统计分析。

结果。手术时患儿的年龄为41（16.5-63）天[5.9（2.4-9）周]。其中，64名儿童（34.2%）出生一个月， 72名儿童（38.5%）出生两个月，51名儿童（27.3%）出生三个月。早产儿有76人（40.6%）。102名儿童（54.5%）接受了紧急手术，85名儿童（45.5%）接受了计划手术。输注含红细胞成分的血红蛋白、血细胞比容和红细胞水平分别为82(77-90)克/升、25(22-28)%和2.8(2.3-3.0) × 1012/升。含红细胞成分的体积为54.0（32.9-74.4）毫升（每公斤体重10-30毫升）。术后需要人工通气的病例为31例（72.1%）， 人工通气时间为48.5小时（22.5-190），而没有输注含红细胞成分的病例为57例（39.6%），人工通气时间为40小时（22-96）。输血指征为不同程度的贫血。然而，值得注意的是，74.4%的患儿在输血的同时接受了拟肾上腺素治疗，以稳定血流动力学：23名（74.2%）患儿接受了多巴胺单药治疗， 8名（25.8%）患儿接受了多巴胺和去甲肾上腺素联合治疗。药物剂量分别为10(8-12)毫克/千克 × 分钟和0.2(0.15-0.4)毫克/（千克 × 分钟）。

结论。使用含红细胞成分的频率为23%。输注含红细胞成分的阈值：血红蛋白82(77-90)克/升，血细胞比容 25 (22-28)%，红细胞 2.8 (2.3-3.0)×1012/升。

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