[Prediction of High-Risk Factors for Survival Outcomes in Children Undergoing Massive Intraoperative Blood...

To analyze the influence of massive transfusion on blood test indexes in children, and to explore the risk factors of survival outcome in order to prevent complications and improve survival rate of children.

One hundred and sixteen children with massive transfusion during operation from January to April 2024 were selected, according to the multiples of the amount of intraoperative blood transfusion and their own blood volume, they were divided into three groups: 1-2 times transfusion volume group (71 cases), >2,≤3 times transfusion volume group (35 cases), >3 times transfusion volume group (10 cases). The difference of blood test indexes before and after massive transfusion in children was analyzed, and the correlation between those differential indicators and transfusion times, and the high risk factors affecting children's survival outcome were predicted.

There were significant differences in blood indexes including hcrp, PT, APTT, TT, FIB, ALT and Ca²⁺.before and after massive transfusion. There were positive correlation between hcrp, PT, APTT, TT, ALT and transfusion times (r=0.053，P=0.040；r=0.118,P=0.020；r=0.186，P=0.045；r=0.046，P=0.034；r=0.075，P=0.042), and negative correlation between FIB, Ca²⁺ and transfusion times(r=-0.096，P=0.031；r=-0.097，P=0.029). hcrp, PT, APTT, TT, ALT were positively correlated with the blood components ratio(r=0.060，P=0.003；r＝0.049，P=0.049；r＝0.149，P=0.046；r＝0.045，P=0.047；r＝0.095，P=0.024), while FIB, Ca²⁺ were negatively correlated with the blood components ratio r＝-0.033，P=0.047；r＝-0.002，P=0.046). Multivariate analysis showed that weight (<2.1 kg), blood loss (>355 ml), operative time (>102.5 min), red blood cell infusion (>2.75 U), plasma infusion (>125 ml), cryoprecipitate infusion (>3 U), PT(>31.8 s), APTT(>78 s), TT(>29.4 s), FIB(<0.85 g/L) were independent risk factors for children's survival outcome.

Massive blood transfusion in children is associated with postoperative complications such as coagulation disorders, liver damage and electrolyte disturbance, the changes of blood transfusion volume and the blood component ratio can affect the severity of symptoms. Low weight, much intraoperative blood loss, long operative time, excessive transfusion volume and coagulation dysfunction can predict high risk of death in children.