先天性心脏病术后出血原因的分析及处理

目的 探索先天性心脏病（先心病）手术后出血的原因及处理方法.方法 纳入2008年5月～2012年12月期间实施体外循环心内直视先心病手术发生术后大出血的患者25例,出血量均＞15ml/kg,其中男13例,女12例,年龄1个月～12岁,体重4.8kg～36.7kg.回顾性分析所有患儿的手术方法、主动脉阻断和转机时间、记录术后出血量并总结止血措施.结果 出血原因依次为：止血不彻底（40%）、肝素未完全中和（24%）、凝血物质减少（20%）和创伤（16%）.处理方法包括,加强血流动力学及引流量的监测,补充凝血物质,彻底中和肝素,必要时二次开胸止血.2例因呼吸循环衰竭而死亡,余均治愈出院,治疗总有效率为92.0%.结论 在体外循环实施先心病手术的过程中应积极调整凝血功能,彻底中和肝素,术中细致操作、彻底止血,以防止术后出血,必要时应及时二次开胸止血.

Causes and managements of bleeding after operation of congenital heart disease

Objective To explore the causes and managements of bleeding after eardiopulmonary bypass （CPB） operation of congenital heart disease. Methods The patients （n=25, male 13 and female 12） with massive bleeding （bleeding quantity〉15 mL/kg averagely） after CPB operation of congenital heart disease were chosen from May, 2008 to Dec. 2012. The age of the patients was from one month to 12 years old and body weight was from 4.8 kg to 36.7 kg. The operation methods, aortic clamp-close time and running time of CPB were retrospectively analyzed, and bleeding quantity was recorded and measures of hemostasis was summed up. Results The causes of bleeding were successively incomplete hemostasis （40%）, incomplete heparin neutralization （24%）, decreased thromboxane material （20%） and trauma （16%）. The managements included enhancing the monitoring of haemodynamics and drainage volume, supplementing thromboxane material, neutralizing heparin completely and stanching with second thoracotomy if necessary. There were 2 cases died due to respiratory and circulatory failure, and others were cured and discharged. The total effective rate was 92.0%. Conclusion During CPB operation of congenital heart disease, the coagulation function should be regulated, heparin should be neutralized completely, and the surgery should be operated carefully for complete hemostasis. The second thoracotomy should be operated in time if necessary for preventing postoperative bleeding.