关键词: RhD阴性, 小儿神外手术, 围术期血液管理

Abstract: Objective  Retrospective analysis of perioperative blood management in RhD-negative children undergoing neurosurgery, and analysis of the characteristics of management of such children to improve clinical prognosis and safety.  Methods  We retrospectively collected the medical records of RhD-negative children who underwent intracranial occupancy resection from 2015 to 2022 and analyzed demographic information, laboratory test results, blood preparation and transfusion-related perioperative blood management. Results  Twenty-three RhD-negative children were included in the analysis. The average age of the children was (7±3.5) years old, preoperative preparation of allogeneic blood was requested in 22 cases (95.7%), 17 cases (73.9%) were successful and 5 cases (21.7%) were unsuccessful in preoperative blood preparation, the time between requesting blood preparation and surgery was (5.8±3) d, and 260 (260, 455) mL of allogeneic red blood cells were prepared, of which 1 case (4.3%) had 400 mL of preoperative autologous stored whole blood. Intraoperative bleeding was 4.8 (2.2, 13.3) mL/kg. Of the 10 blood transfusions, 7 (30.4%) were transfused with allogeneic red blood cells only, 1 (4.3%) was transfused with allogeneic red blood cells and autologous red blood cells, 1 (4.3%) was transfused with autologous red blood cells, and 1 case (4.3%) was transfused with 150 mL of stored whole blood. The transfusion rate was 43.5%, with the crossmatch to transfusion (C/T) ratio of 2.7, and transfusion index (Ti) of 1. Intraoperative arterial blood gas analysis was performed in 12 (52.2%) cases, thromboelastography was monitored in 2 (8.7%) cases. Postoperative hemoglobin was （117±19.4） g/L. Mild anemia was observed in 6 (26.1%) cases, and moderate anemia was observed in 2 (8.7%) cases after surgery. Conclusions  It is necessary to formulate a blood transfusion plan and reasonable perioperative blood management according to the type and location of the child's lesion and adopt a multimodal treatment strategy to reduce bleeding and the dependence on allogeneic RhD-negative blood to ensure the safety of the child's surgery.

Key words: RhD-negative, pediatric neurosurgery, perioperative blood management