中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2022, Vol. 20 ›› Issue (3): 282-286.doi: 10.19438/j.cjoms.2022.03.014

• 论著 • 上一篇    下一篇

19例合并凝血功能异常的腭裂患儿围术期处理

褚珺1, 胡明1, 王国民2, 吕挺正1   

  1. 1.上海交通大学医学院附属上海儿童医学中心 小儿外科,上海 200127;
    2.上海交通大学医学院附属第九人民医院 口腔颅颌面科,上海交通大学口腔医学院, 国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海 200011
  • 收稿日期:2021-07-21 修回日期:2022-02-10 出版日期:2022-05-20 发布日期:2022-05-20
  • 通讯作者: 胡明,E-mail：huming@scmc.com.cn
  • 作者简介:褚珺（1971-）,女,学士,E-mail：chujun@scmc.com.cn

Retrospective study on perioperative management of19children with cleft palate, coagulation disorders

CHU Jun1, HU Ming1, WANG Guo-min2, LYU Ting-zheng2   

  1. 1. Department of Pediatric Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine. Shanghai 200127;
    2. Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Disease; Shanghai Key Laboratory of Stomatology. Shanghai 200011, China
  • Received:2021-07-21 Revised:2022-02-10 Online:2022-05-20 Published:2022-05-20

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摘要： 目的: 探讨腭裂合并凝血功能异常患儿的围术期预防性血液替代治疗方法,为提高手术安全性提供参考。方法: 以2011年11月—2019年11月上海交通大学医学院附属上海儿童医学中心小儿外科收治的38例腭裂患儿作为研究对象,其中19例腭裂合并凝血功能异常（异常组）,19例腭裂未合并凝血功能异常（对照组）。异常组中,6例确诊为血友病（甲型3例,乙型2例,丙型1例）,另13例患儿术前常规检查首次发现凝血功能异常。围术期通过凝血因子、凝血酶原复合物以及新鲜冰冻血浆等血液替代疗法纠正凝血功能后,行腭裂修补术。采用SPSS 22.0软件包,对2组患儿平均手术时间、术中出血量、平均住院天数等临床资料进行统计分析。结果: 通过围术期预防性血液替代治疗,异常组18例患儿术前活化部分凝血活酶时间（APTT）显著改善,顺利完成手术,未出现手术并发症。1例患儿术中出血约250 mL,术中输注凝血酶原复合物、血浆及红细胞悬液,术后常规对症治疗后恢复顺利,未出现术后并发症。2组间术中出血量、住院时间等无统计学差异（P>0.05）。结论: 围术期正确实施预防性血液替代治疗,可有效降低腭裂合并凝血功能异常患儿术中、术后出血并发症,提高手术安全性。

关键词: 腭裂, 凝血功能异常, 血液替代治疗, 儿童, 围术期

Abstract: PURPOSE: To discuss the perioperative prophylaxis for children with cleft palate and coagulation disorders in order to improve surgical safety. METHODS: A retrospective study was conducted between November, 2011 and November, 2019 from the Department of Pediatric Surgery, Shanghai Children's Medical Center, identified 38 patients with cleft palate, among whom 19 were complicated with coagulation disorders (abnormal group) and 19 were included as control. Six of 19 patients in the abnormal group were previously diagnosed hemophilia (3 were hemophilia A, 2 were hemophilia B, 1 was hemophilia C),and the remaining 13 patients were first diagnosed with abnormal coagulation by routine preoperative examinations. All patients in the abnormal group underwent prophylactic blood substitution with blood coagulation factors, prothrombin complex concentrate or fresh frozen plasma before surgery. The average surgery time, intraoperative blood loss and average hospitalization days were statistically analyzed with SPSS 22.0 software package. RESULTS: In the abnormal group, 18 of 19 patients' APTT improved obviously before surgery,and underwent surgical treatment successfully and recovered without any surgical complications after prophylactic blood substitution. One patient suffered from hemorrhage of about 250 mL and had fully recovery after intraoperative PPSB, plasma and red blood cell treatment. The intraoperative blood loss and average hospitalization days between the two groups had no significant difference(P>0.05). CONCLUSIONS: Appropriate application of perioperative blood substitution can effectively reduce intra- and post-operative bleeding for patients with cleft palate and coagulation disorders and improve surgical safety.

Key words: Cleft palate, Coagulation disorder, Blood substitution, Children, Perioperative period

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