库存红细胞清洗在新生儿及小婴儿体外循环手术中的应用

目的 对比体外循环(CPB)心脏手术中接受洗涤及未洗涤的库存红细胞(PRBC)对血清钾离子浓度(K+)及乳酸浓度(LAC)的影响.方法 选取复杂先天性心脏病(先心病)行CPB心脏手术的新生儿及小婴儿为研究对象,排除术前血乳酸大于3.0mmol/L的病婴.对照组(15例)接受未洗涤的PRBC进行CPB预充及术中添加,试验组(15例)接受用血液回收机(Medtronic Autolog)洗涤过的PRBC.在CPB前、CPB 3、15min、CPB复温、停止CPB前、术毕、术后4、24h比较血K+及LAC浓度.结果 洗涤PRBC显著降低供血中K+浓度从(19.3±0.9)mmol/L降至(1.1±0.3)mmol/L,p<0.001]及IAC浓度从>15mmol/L降至(7.8±1.2)mmol/L,P<0.001].对照组预充液的K+及ILAC浓度显著高于试验组K+(9.0±0.5)rranol/L对(2.6±0.1)mmol/L,P<0.001;LAC浓度(9.5±0.5)mmol/L对(4.7±1.1)nrml/L,P<0.001].CPB 3min、CPB复温时对照组血清K+浓度显著高于试验组CPB 3 min(5.6±0.9)mmol/L对(3.5±0.4)mmol/L,P<0.01;CPB复温时(4.8±0.7)mmol/L对(3.7±0.6)mmol/L,P<0.01];其余时点对照组K+浓度高于试验组,差异无统计学意义.CPB 3、15 min、CPB复温、停止CPB前、术毕、术后4 h对照组IAC浓度高于试验组,但差异无统计学意义.结论 洗涤PRBC降低血清钾及乳酸负荷,可预防cPB中高血钾.在新生儿及小婴儿复杂先心病CPB手术中应考虑应用清洗PRBC.

Transfusin of wash-packed red blood cells during cardiopulmonary bypass in neonates and small infants

Objective Priming blood in cardiopulmonary circuit is necessary for neonates and small infants. However, high concentration of potassium and lactate in pecked red blood cells transfused during cardiopulmonary bypass may have detrimental effects on meonstea and infants undergoing cardiac surgery. This study is to cornice the effects of trasfusing washed end unwashed peeked red blood cells for cardiopulmonary circuit on serum potassium and lactate concentrations preoperatively. Methods 30 neonates and small infants with complex congenitai heart disease undergoing open heart surgery were divided into 2 groups randomly. Unwashed group (n = 15) received unwashed pecked red blood cells and washed group (n=15) received packed red blood cells washed in a cell saver (Medtronic Autolog). Potasium and lactate concertrations were compared before, during and after bypass. Resuils Wash-packed red blood cells reduced donor blood K+] from (19.3±0.9)mmd/L to (1.1 +0.3) mmol/L, and lactate from 15 mmo/L to (7.8±1.2) mmol/L (P<0.001). The K+]in the prime solution was significantly higher (9.0±0.5) mmol/L vs. (2.6±0.1) mmol/L, P<0.001] in umwashed group than that of washed group, so did the lactate (9.5±2.6) mmol/L vs. (4.7±1.1) mmol/L, P