在患有先天性和获得性凝血病的儿科患者中进行外科手术的考虑
Gabor Erdoes1, Susan M Goobie2, Thorsten Haas3
1Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
BJA open
|October 8, 2024
概括
接受手术或创伤的儿科患者可能会出现严重的出血障碍 (凝血病). 目前的监测缺乏特定年龄的值,需要专家的共识,有效的外科手术管理,直到进一步的研究是可用的.
科学领域:
- 儿科麻醉学 儿科麻醉学
- 血液学 血液学 血液学
- 外科手术静血 静血是什么
背景情况:
- 儿童,特别是新生儿和婴儿,由于不成熟的静血系统和未被诊断的出血障碍,面临高风险的术后凝血病.
- 传统的凝血测试正在通过动态监测策略来补充,例如高风险程序的粘弹性测试.
- 对于诊断和管理儿科凝血病的特定年龄参考值存在关键差距.
研究的目的:
- 审查当前的外科手术指南,监测技术和儿科凝血病的治疗选择.
- 为了突出有效管理,需要验证的年龄特定数据.
- 强调专家共识在缺乏强有力的证据的情况下指导术后护理的作用.
主要方法:
- 对当前儿科凝血病的外科手术指南和监测策略的审查.
- 讨论粘弹性测试和血小板功能分析作为先进的监测工具.
- 检查有针对性的治疗方式,包括特兰胺酸,因子缩剂和血液成分输血.
主要成果:
- 粘弹性测试越来越多地被采用用于监测高风险儿科手术患者的凝血病.
- 血小板功能分析仪为血小板异常提供了有前途的查.
- 目前的管理依赖于专家的共识,因为缺乏具有特定年龄数据的前性研究.
结论:
- 儿童凝血病的有效外科治疗需要特定年龄的参考值和经过验证的目标导向策略.
- 专家的共识应该指导管理,直到进一步的研究提供必要的数据.
- 个性化治疗方法对于治疗儿科手术患者的出血障碍至关重要.
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