脊柱側弯症矯正手術を受けた小児患者における出血が脳酸素飽和度に及ぼす影響：後方視的観察研究

Influence of blood loss on cerebral oxygen saturation in paediatric patients undergoing surgery for scoliosis correction: A retrospective observational study.

抄録

目的:

小児における先天性側弯症の矯正手術はしばしばかなりの出血を伴う。局所酸素飽和度（rScO）の低下は脳灌流不足を反映し、神経学的合併症を予測しうる。このレトロスペクティブ観察研究では、小児における手術中の出血とrScOの低下との関係を検討した。

AIM: Surgery for congenital scoliosis correction in children is often associated with considerable blood loss. Decrease in regional oxygen saturation (rScO) can reflect insufficient cerebral perfusion and predict neurological complications. This retrospective observational study explored the relationship between blood loss during this surgery and a decrease in rScO in children.

方法:

2019年3月～2021年7月に選択的後側弯矯正術を受けた3～14歳の小児の以下の臨床データを収集した：年齢、性別、身長、体重、ベースラインrScO、基礎平均侵襲動脈圧（MAP）、術前コブ角、手術セグメント数、術前および術後のヘモグロビン値、手術中にベースライン値より低いrScOが3分以上持続した割合（ベースラインからのrScOの低下、D-rScO％）、術中平均侵襲MAP、潮内炭酸ガス圧、晶質輸液と膠質輸液の輸液速度、手術時間、総失血量/患者血液量の割合（TBL/PBV）。

METHODS: The following clinical data of children aged 3-14 years who underwent elective posterior scoliosis correction between March 2019 and July 2021 were collected: age, sex, height, weight, baseline rScO, basal mean invasive arterial pressure (MAP), preoperative Cobb angle, number of surgical segments, preoperative and postoperative haemoglobin level, percentage of lowest rScO below the baseline value that lasted 3 min or more during the operation (decline of rScO from baseline, D-rScO%), intraoperative average invasive MAP, end-tidal carbon dioxide pressure, fluid infusion rate of crystalloids and colloids, operation time, and percentage of total blood loss/patient's blood volume (TBL/PBV).

結果:

合計105例の小児が研究に組み入れられた。大量出血（TBL/PBV≧50％）は53.3％の患者で報告され、これらの患者は非大量出血（TBL/PBV＜50％）の患者よりもD-rScO（％）が有意に高かった（t＝-5.264、P＜0.001）。重回帰分析の結果、TBL/PBV（β=0.04、95％CI：0.018-0.062、P<0.05）はD-rScO％と有意に関連していた。

RESULTS: A total of 105 children were included in the study. Massive haemorrhage (TBL/PBV ≥50%) was reported in 53.3% of patients, who had significantly higher D-rScO (%) (t = -5.264, P < 0.001) than those who had non-massive haemorrhage (TBL/PBV <50%). Multiple regression analysis revealed that TBL/PBV (β = 0.04, 95% CI: 0.018-0.062, P < 0.05) was significantly associated with D-rScO%.

結論:

小児の術中大量出血はD-rScO％を有意に増加させた。重要臓器への血液および酸素供給を確実に維持し、麻酔の安全性を向上させ、神経学的合併症を回避するために、モニタリングを改善し、適時血液補充を行うべきである。

CONCLUSIONS: Intraoperative massive blood loss in children significantly increased D-rScO%. Monitoring should be improved, and timely blood supplementation should be performed to ensure maintenance of the blood and oxygen supply to vital organs, improve the safety of anaesthesia, and avoid neurological complications.