小儿体外循环心脏手术中采用无血预充的探讨

目的：探讨小儿体外循环心内直视手术中采用无血预充的临床价值。方法：50例12～20 kg先天性心脏病室间隔缺损(VSD)及继发孔房缺(ASD)小儿，随机分为观察组(n=25)和对照组(n=25)，分别采用无血预充和有血预充，比较两组术中、术后红血球压积(Hct)、速尿用量、尿量、术后清醒时间、辅助通气时间及心包、纵隔引流量。结果：观察组术中和术后12 h Hct(19.0±6.8)%，(30.4±25.2)%明显低于对照组(23.4±10.6)%，(33.2±23.4)%，P0.05；清醒时间，辅助通气时间及引流量两组无显著性差异，P>0.05。结论：无血预充小儿体外循环心内直视手术是安全可行的。

Cardiopulmonary Bypass with the Bloodless Priming Technique in Open heart Surgery in Children

Objective To explore the effect of cardiopumlonary bypass using the bloodless priming technique in open-heart surgery in children. Methods Fifty cases of atrial septal defect (ASD) or ventricular atrial septal (VSD) were randomly divided into a bloodless priming group (n=25) and a control group receiving blood priming (n=25). The Hct, furosemide dosage, urine output, pericardial and mediastinal drainage, and time of wakening and of mechanical ventilatory support were deternined intra operatively and postoperatively. Results The intra and 12 h post operative Hct ( 19.0 ± 6.8 ) % and ( 30.4 ± 25.2 )%, respectively] in the bloodless group was lower than that in the blood primed group ( 23.4 ± 10.6 )% and ( 33.2 ± 23.4 )%, respectively] (P< 0.05 ). The intra and post operative doses of furosemide ( 5.2 ± 0.8 ) mg and ( 4.5 ± 0.6 ) mg, respectively] in the bloodless group were larger than those in the blood primed group ( 1.2 ± 1.0 ) mg and ( 1.5 ± 0.5 ) mg, respectively] (P< 0.05 ). The intra and 24 h post operative urine output in the blood less group (218±56) ml and (278±38) ml, respectively] was higher than that in the blood primed control group (78±36) ml and (189±62) ml, respectively]. The Hct did not differ between the bloodless group and blood primed group 24 h after the operation ( 38.6 ± 25.2 ) % vs ( 38.8 ± 24.3 ) %]. Pericardial and mediastinal drainage and time of wakening and post operative mechanical ventilatory support did not differ in the two groups. Conclusions Cardio pulmonary bypass using the bloodless priming tecnique appears to be safe and practicable in pediatric open heart surgery procedures.