低体重患儿围体外循环期实施新节约用血策略的研究

目的分析新的节约用血策略对低体重（≤8kg）先天性心脏病患儿实现无血体外循环或减少围术期血液制品用量的可行性及对患儿早期预后的评价。方法自2011年8月至2012年1月共有76名低体重患儿分成两组，对照组（n=38）采用体外循环经典预充血策略，即2个单位悬浮少白红细胞（PRBC）和100ml新鲜冰冻血浆（FFP）完成心脏畸形矫治术；实验组（n=38）低体重患儿实施体外循环无血预充技术并结合新节约用血策略，术中根据患儿血红蛋白浓度的变化再适量补充悬浮红细胞。收集两组患儿围术期的重要监测指标及血液制品（悬浮红细胞、新鲜冰冻血浆）的用量、术后24h胸液量及患儿术后早期恢复的评价指标。结果实验组患儿平均每例输入PRBC和FFP的用量均明显少于对照组（P〈0．01）；实验组中有12例患儿实施无血体外循环手术，且术前血红蛋白浓度显著高于另外26例患儿（P〈0．05），另外26例术中每例各加入1单位悬浮红细胞，每例患儿血浆用量为零；两组患儿24h胸液量无显著性差异（P〉0．05）；两组患儿的术后机械通气时间和ICU停留时间无显著差异（P〉0．05）。结论合理实施新节约用血策略可显著减少低体重先天性心脏病患儿的血液制品用量，未对患儿术后早期带来不良影响；术前红细胞比容大于0．36者，较易实现无血体外循环管理。

Application of a new blood saving strategy in low-weight infants with congenital heart disease during cardiopulmonary bypass

Objective To evaluate the effect of a new blood saving strategy on reducing allogeneic blood transfusion and early postoperative prognosis in low-weight patients with congenital heart disease(CHD). Methods Seventy-six low-weight infants with CHD were divided into two groups since August in 2011 to January in 2012.In the control group(n=38),all infants were applied with conventional priming protocol with 2 u packed red blood cell(PRBC) and 100ml fresh frozen plasma(FFP);All infants in the experimental group(n=38) underwent the new blood saving strategy with bloodless priming in cardiopulmonary bypass(CPB).The allogeneic blood transfusion in the two groups was collected respectively;the amount of chest-tube drainage during postoperative 24 hr and the changes of perioperative hemoglobin in each group were monitored. Results Each case in the experimental group was transfused with PRBC and FFP significantly less than that of in the control group(P<0.01);Twelve cases in the experimental group underwent bloodless CPB,and the other 26 cases were added 1u PRBC respectively during CPB,and no FFP were added in the CPB circuit.The chest-tube drainage during postoperative 24hr has no significant difference between the two groups(P>0.05);There was no significant difference between the two groups as to the mechanical ventilation and ICU stay time(P>0.05). Conclusion The application of new blood saving strategy has a significant effect on reducing allogeneic blood transfusion,and also it has no side effect on the recovery of low weight infants.If the patient’s hemoglobin reached more than 120 g/L,the open heart surgery with bloodless CPB will be available.