先天性心脏病患儿围术期凝血功能监测

目的使用Sonoc lot凝血与血小板功能分析仪(Sonoclot分析仪)监测非紫绀型及紫绀型先天性心脏病患儿围术期凝血功能的变化并评价其可行性。方法随机选择先心病患儿60例,分为非紫绀型(N组,n=30)和紫绀型(C组,n=30)两组,分别于麻醉诱导后(T1)和鱼精蛋白中和肝素10 m in后(T2)抽颈内静脉血,检测激活凝血时间(SonACT)、凝集速率(Clot Rate)、血小板功能(PF)并记录术后24h胸腔引流量。结果组内比较:与T1相比,T2时点N组与C组患儿的SonACT、Clot Rate、PF均发生改变,其差异有统计学意义(P<0.05)。组间比较:T1、T2时点,N组与C组间的C lotRate有统计学差异(P<0.01);N组与C组患者术后24h胸腔引流量有统计学差异(P<0.01)。结论体外循环可引起非紫绀型与紫绀型先心病患儿的凝血功能降低;紫绀型先心病患儿的Clot Rate在体外循环前后均低于非紫绀型,因而术后更易发生出血;Sonoclot分析仪能准确反映患者围术期凝血功能的变化,适用于儿童凝血功能的监测。

Monitoring the Perioperative Coagulation Function of Children with Congenital Heart Disease

OBJECTIVE Using Sonoclot coagulation and platelet function analyzer system to monitor the coagulation function of children with acyanotic or cyanotic congenital heart disease and evaluate this method.METHODS 60 children with congenital heart disease were collected randomly and divided into acyanotic group(N group,n=30)and cyanotic group(C group,n=30).Central venous blood was withdrawed to measure SonACT,Clot Rate and PF at the following time points: after anesthesia(T1),10 minutes after protamine administration(T2),and 24 hour mediastinal chest tube drainage was recorded.RESULTS The SonACT,Clot Rate and PF of N and C groups both changed at T2 compared with those at T1.The Clot Rate of N group has significantly statistic difference at T1,T2 compared with that of C group.24 hour mediastinal chest tube drainage has significantly difference between two groups.CONCLUSION Extracorporeal circulation(ECC) impaired the coagulation function of children with acyanotic or cyanotic congenital heart disease.The Clot Rate of children with cyanotic congenital heart disease was worse than that of children with acyanotic congenital heart disease.Cyanotic patients bleed more easily after operation.Sonoclot analyzer system could monitor patients' coagulation function accurately,and it could be used in children.