小儿体外循环心脏手术中采用无血预充的探讨

Cardiopulmonary Bypass with the Bloodless Priming Technique in Open heart Surgery in Children

摘要:

目的：探讨小儿体外循环心内直视手术中采用无血预充的临床价值。方法：50例12～20 kg先天性心脏病室间隔缺损(VSD)及继发孔房缺(ASD)小儿，随机分为观察组(n=25)和对照组(n=25)，分别采用无血预充和有血预充，比较两组术中、术后红血球压积(Hct)、速尿用量、尿量、术后清醒时间、辅助通气时间及心包、纵隔引流量。结果：观察组术中和术后12 h Hct(19.0±6.8)%，(30.4±25.2)%明显低于对照组(23.4±10.6)%，(33.2±23.4)%，P<0.05；术中和术后速尿用量(5.2±0.8) mg，(4.5±0.6) mg高于对照组(1.2±1.0) mg，(1.5±0.5) mg，P<0.05；术中和术后尿量(218±56) ml，(278±38) ml多于对照组(78±36) ml，(189±62) ml，P<0.05；术后24 h Hct(38.6±25.2)%与对照组(38.8±24.3)%比较无显著性差异，P>0.05；清醒时间，辅助通气时间及引流量两组无显著性差异，P>0.05。结论：无血预充小儿体外循环心内直视手术是安全可行的。

Abstract:

OBJECTIVE: To explore the effect of cardiopumlonary bypass using the bloodless priming technique in open-heart surgery in children. METHODS: Fifty cases of atrial septal defect (ASD) or ventricular atrial septal (VSD) were randomly divided into a bloodless priming group (n=25) and a control group receiving blood priming (n=25). The Hct, furosemide dosage, urine output, pericardial and mediastinal drainage, and time of wakening and of mechanical ventilatory support were deternined intraoperatively and postoperatively. RESULTS: The intra and 12 h post operative Hct ［(19.0±6.8) % and (30.4±25.2)%, respectively］ in the bloodless group was lower than that in the blood primed group ［(23.4±10.6)% and (33.2±23.4)%, respectively］ (P<0.05). The intra and post operative doses of furosemide ［(5.2±0.8) mg and (4.5±0.6) mg, respectively］ in the bloodless group were larger than those in the blood primed group ［(1.2±1.0) mg and (1.5±0.5) mg, respectively］ (P<0.05). The intra and 24 h post operative urine output in the blood less group ［(218±56) ml and (278±38) ml, respectively］ was higher than that in the bloodprimed control group ［(78±36) ml and (189±62) ml, respectively］. The Hct did not differ between the bloodless group and bloodprimed group 24 h after the operation ［(38.6±25.2) % vs (38.8±24.3) %］. Pericardial and mediastinal drainage and time of wakening and postoperative mechanical ventilatory support did not differ in the two groups. CONCLUSIONS: Cardiopulmonary bypass using the bloodless priming tecnique appears to be safe and practicable in pediatric openheart surgery procedures.