体重≤5 kg婴儿简单先天性心脏病外科术中微小化体外循环管路应用改良超滤和常规超滤的比较

目的:比较利用微小化体外循环(CPB)管路行简单心脏手术时是否使用改良超滤(MUF)对体重≤5 kg先天性心脏病(先心病)婴儿的影响。方法:选取2018年1月至2020年6月在我院行CPB下简单心脏手术,体重≤5 kg先心病婴儿(手术年龄:18天~11个月)208例。其中,CPB中使用MUF的婴儿纳入MUF组(n=128);仅使用微小化管路合并常规超滤(CUF)的婴儿纳入CUF组(n=80)。比较两组婴儿术后不同时间点的血液学检测结果以及其他围术期资料。结果:CUF组的残余机血量和残余机血量/体重均显著高于MUF组;CUF组CPB中的红细胞压积(Hct)显著高于MUF组(25.25±2.68)%vs.(24.47±3.82)%,P=0.000],而MUF组撤除CPB后的Hct显著高于CUF组(30.88±4.51)%vs.(29.24±3.33)%,P=0.003];CUF组于心脏重症监护室早期血清乳酸浓度显著低于MUF组入心脏重症监护室时:(1.59±0.60)mmol/L vs.(1.85±1.08)mmol/L,P=0.032;入心脏重症监护室后3 h:(1.31±0.61)mmol/L vs.(1.62±1.00)mmol/L,P=0.006],差异均有统计学意义。两组术后输血率和输血量差异均无统计学意义。结论:与MUF相比,CUF并未带来不良影响,还能简化管路和操作,可安全用于婴儿CPB手术。

Effects of Modified and Conventional Ultrafiltration During Simple Congenital Heart Surgery in Infants Weighing Less Than 5 kg

Objectives:To compare the effects of modified(MUF)and conventional ultrafiltration(CUF)during simple congenital heart surgery using minimal cardiopulmonary bypass(CPB)circuit in infants weighing less than 5 kg.Methods:A total of 208 children with body weight≤5 kg who underwent simple cardiac surgery under CPB at Department of Cardiac Surgery,Guangzhou Women and Children’s Medical Center from January 2018 to June 2020 were included.Patients were divided into MUF group(n=128)and CUF(n=80)according to whether MUF was used or not.Hematological test results and other perioperative data were compared between the two groups.Results:Packaged blood volume and packaged blood volume/body weight were significantly higher in CUF group than those in MUF group.The Hct was also significantly higher in CUF group than that in MUF group(25.25±2.68]%vs.24.47±3.82]%,P=0.000),while the Hct was significantly higher in MUF group than that in CUF group(30.88±4.51]%vs.29.24±3.33]%,P=0.003)after CPB removal.The early postoperative lactic acid concentration was significantly lower in CUF group than in MUF group.Postoperative blood transfusion rate and volume were similar between the two groups.Conclusions:CUF is comparable to MUF,and can simplify CPB circuit,so CUF can be safely used in CPB surgery for neonates and infants.