两种血浆代用品对婴幼儿体外循环术后转归的影响

目的观察4%琥珀酰明胶和6%羟乙基淀粉130/0.4用于婴幼儿体外循环（extracorporeal circulation,ECC）预充对术中血乳酸和术后转归的影响。方法30例择期行心内畸形矫治术的婴幼儿患者,随机分为2组,每组15例。分别应用4%琥珀酰明胶（佳乐施）和6%羟乙基淀粉130/0.4（万汶）进行ECC预充。记录两组患儿代血浆用量和库血使用量,检测ECC中15 min、终止ECC 5 min和2 h的血乳酸浓度,检测ECC中15 min和终止ECC 2 h的血红蛋白。记录两组患儿术后24 h引流液量及尿量、苏醒时间、呼吸机使用时间、ICU停留时间、术后并发症发生率、多巴胺/多巴酚丁胺用量以及术毕肌酐、尿素氮含量等。结果两组患儿均痊愈出院,两组间各项指标均无显著性差异。结论佳乐施和万汶用于婴幼儿ECC预充对术中血乳酸和术后转归无影响,不会增加并发症,两种血浆代用品均可安全用于婴幼儿ECC。

The Effects of Two Plasma Substitutes on Post Extracorporeal Circulation Outcome in Infants

OBJECTIVE To observe the changes of lactate level and postoperative outcome following 4% succinylated gelatin（Gelofusine） or 6% hydroxyethyl starch 130/0.4（Voluven） priming for extracorporeal circulation（ECC） in infants.METHODS 30 cases underwent congenital open heart surgery were randomly divided into two groups： Gelofusine group（n=15） with 4%Gelofusine prime;Voluven group（n=15） with 6% Voluven prime.The volume of plasma substitutes and the volume of homologous transfusion during ECC were recorded.The lactic acid concentration at ECC 15 min,5 min and 2 h after weaning from ECC,and the hemoglobin at ECC 15 min and 2 h after weaning from ECC were measured.Also the chest drainage,urine output after ECC 24 h,recovery time,mechanical ventilating time,the length of ICU stay,the incidence of postoperative complication,postoperative dopamine / dobutamine doses,creatinine and urea nitrogen content after the surgery were recorded.RESULTS These two groups were all recovery well.There were no significant difference in lactic level and postoperative outcome between the two groups.CONCLUSION Gelofusine and Voluven are safe colloid solution for ECC priming in infants,they are no effect on lactate level,postoperative outcome and the complication.