6%HEL130/0.4在体外循环心内直视术患儿中的临床应用

目的通过体外循环心内直视术患儿预充6%羟乙基淀粉（HEL）130/0.4对血流动力学及凝血功能的影响,探讨其临床应用的价值。方法 80例体外循环低温全麻心脏手术患儿,随机分为6%HEL130/0.4组（A组）和对照组（B组）,每组40例,A组在体外循环中预充6%HEL130/0.4400ml,B组在体外循环中预充血浆400ml,体外循环前后监测心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）。体外循环前后分别抽取静脉血测定：（1）红细胞比容（HCT）,血沉（BSR）;（2）血小板计数（PLC）,凝血酶原时间（PT）,激活全血凝固时间（ACT）。观察术前、心肺转流15min、回ICU、术后24h上述指标的变化。结果两组HCT、PLC在体外循环后均显著降低（P〈0.05）,BSR均显著加快（P〈0.05）,两组HR、MAP、CVP、PLC、ACT、PT体外循环前后差异无统计学意义（P〉0.05）。结论 6%HEL130/0.4作为小儿体外循环稀释液用于小儿心内直视手术效果确切、安全性高。

Application of hydroxyethyl starch infusion during cardiopulmonary bypass operation in children

Objective To observe the effect of hydroxyethyl starch（HES）infusion on blood dynamics and coagulation in children who undergo cardiopulmonary bypass.Methods A total of 80 children who would received cardiopulmonary bypass were divided into two groups at random.Trial group（n=40）was infused with HES（6%,400 ml）and control group（n=40）was infused with plasma（400 ml）before cardiopulmonary bypass.The mean arterial pressure（MAP）,heart rate（HR）,center venous pressure（CVP）were detected for both the groups before and after cardiopulmonary bypass,and Hct,BSR,PLC,PT and ACT were also measured.The parameters were observed before operation,15 minutes after cardiopulmonary bypass,just return to ICU and 24 hours after operation.Results Hct and PLC were significantly lower in both the groups than that before cardiopulmonary bypass,and BSR was obviously faster than that before cardiopulmonary bypass（P〈0.05）.There were no significant differences in HR,MAP,CVP,PLC,ACT and PT between before and after cardiopulmonary bypass（P〉0.05）.Conclusion HES infusion is a safe method during cardiopulmonary bypass.