体外循环后控制性机血回输的临床研究

【目的】观察体外循环后控制性机血回输对胸液量和激活全血凝血时间（ACT）的影响。【方法】112例心脏瓣膜置换病人随机分为A、B两组，A组为机血通过中心静脉1～3h输完，并常规每100mI。机血给5mg鱼精蛋白中和。B组为体外循环（CPB）停机鱼精蛋白中和后10min内肝素血主动脉管输完，残余管道部分弃置。两组的麻醉、病人体外循环及停机后体内肝素中和方法相同。观测CPB后ACT值、关胸止血时间及术后24h胸液量。【结果】B组比A组ACT更接近生理值（P〈0．05），关胸止血时间明显缩短（P〈0．01），且胸液量明显减少（P〈0．01）。【结论】心脏手术中鱼精蛋白中和后10min内肝素血输完，能明显缩短手术时间，减少术后胸液渗量，减少库血的应用，临床操作方便和实用。

Clinical Study of Controlled Machine Blood Re-transfusion After CPB

Objective] To observe the effect of controlled machine blood re-transfusion after cardiopulmonary bypass（CPB） on the chest fluid volume and activated whole blood coagulation time（ACT）. Methods] Totally 112 patients undergoing heart valve replacement were divided into group A and group B. In group A, the machine blood in group A was transfused over through the central vein within 1-3 hours, and per 100ml machine blood was neutralized with 5mg protamine. In group B, the heparin blood was transfused over through aorta within 10min after CPB and the neutralization with protamine. The remaining tubes were discarded. The anesthesia way and heparin neutralization method after CPB of patients were identical. The ACT value after CPB, the time of hematischesis and chest closure and 24h chest fluid volume after operation were observed. Results] Compared with group A, the ACT value in group B was closer to physiological value（ P 〈0.05）, and the time of hematischesis and chest closure were shortened obviously（ P 〈0.01）, and the chest fluid volume significantly reduced（ P 〈0. 01）. Conclusion] If heparin blood is transfused over within 10min after the neutralization with protamine during heart surgery, the operation time will be shortened obviously, and the chest fluid volume after operation will be decreased, and the use of banked blood will be reduced, and the clinical procedure will be convenient and practical.