小儿心内直视手术控制胶体渗透压的研究

目的：探讨小儿心脏直视手术围体外循环期胶体渗透压的变化规律。方法：将68例先心病患儿随机分成4组，分别以晶体液、血浆、人血白蛋白、血定安预充，观察胶体渗透压和临床一些指标的变化及比较组织的湿干重比。结果：以人血自蛋白、血定安预充与以晶体液、血浆预充相比，前两者能够在体外循环中维持较理想的胶体渗透压；组织的湿干重比升高幅度较小；术后辅助呼吸时间较短，出现眼球结膜、眼睑水肿的比率较低。结论：维持小儿体外循环过程中适当的胶体渗透压有助于患儿康复，减少并发症；以人血自蛋白和血定安预充能够较好维持所需水平的胶体渗透压，且安全、有效。

A Study on Colloid Osmotic Pressure for Cardiopulmonary Bypass in Children

Objective: To assess the status of colloid osmotic pressure (COP) for cardiopulmonary bypass (CPB) in children.Methods:We investigated the effect of crystalloid (Group A, n =18, COP: 0.16 kPa), plasma (Group B, n =17, COP: 0.98 kPa), human albumin (Group C, n =15, COP: 2.8 kPa), and gelofusine (Group D, n =18, COP: 2.5 kPa) as CPB primes in 68 randomized children undergoing elective CPB surgery for congenital heart diseases. The COP at the beginning, 10 minutes, 30 minutes and the end of CPB and 6 hours, 24 hours and 48 hours after CPB were measured and the ratios of wet to dry of tissue (W/D) before and after CPB were assessed. The supportively ventilative time, perfusion pressure, urine volume during CPB and chest tube drainage, urine volume after 24 hours were measured and the status of the edema and the convalesce of patients were observed.Results:The COP level during CPB can be maintained at a proper level with less increase of the W/D ratios, less supportively ventilative time and less occurrence of the edema in Group C and D versus Group A and B.Conclusion:We conclude that the maintenance of COP at proper level during CPB is important for CPB surgery for children; human albumin and gelofusine as CPB primes may keep the proper COP level and gelofusine is the substitute for human albumin characteristics of safety, effectiveness and lower cost.