自体血逆行预充对体外循环期间血液有形成分影响的观察

目的观察自体血逆行预充(RAP)技术应用在体外循环(CPB)心脏手术中对血液有形成分的影响。方法选取单瓣膜置换术患者40例,随机分为RAP组20例;常规预充组(CP组)20例。RAP组于CPB开始前用患者自体血置换出部分预充液。对比两组患者肝素化10 min(T1)、CPB 30 min(T2)、鱼精蛋白中和后10 min(T3)、CPB终止1 h(T4)患者静脉血标本的红细胞(RBC)、白细胞(WBC)、血红蛋白(Hb)、血浆游离血红蛋白(FHb)、血小板(Plt)和纤维蛋白原(Fib)等含量以及红细胞比容(Hct)和D-二聚体(D-dimer)等指标的变化,并记录术中库存红细胞(悬红)用量。结果 RAP组平均置换预充液量为(663.2±167.4)ml。术中悬红用量RAP组少于CP组(P0.05)。RAP组患者T2、T3的Hct水平高于CP组(P0.05)。RAP组RBC计数和Hb含量在T2、T3比CP组高(P0.01,P0.05)。Plt计数、FHb含量、Fib和D-dimer水平在各时间点测定值两组间比较均无统计学差异。结论在CPB中采用RAP可减少CPB预充量,降低血液稀释度,减少异体血用量,对血液有形成分无显著损伤性改变。

Effects of retrograde autologous priming on blood components in adults single valve repalcement

OBJECTIVE To investigate the influence of retrograde autologous priming on blood components during and after cardiopulmonary bypass（CPB） in adults single valve replacement for adults.METHODS 40 patients with rheumatic heart disease undergoing single valve replacement were randomly divided into two groups： RAP group（n=20） received retrograde autologous priming and CP group（n=20） received conventional priming.Red blood cell（RBC）,white blood cell（WBC）,platelet（Plt）,hemoglobin（Hb）,free hemoglobin（FHb）,hematocrit（Hct）,and D-dimer were measured at four time points：10 min after heparin as baseline（T1）,30 min following CPB（T2）,10 min after heparin neutralization by protamine（T3）,and 1h after CPB（T4）.RESULTS There were no differences in preoperative parameters between two groups.However,the levels of RBC were significant higher at T2 and T3 in RAP group compared to CP group（P〈0.03）,the levels of WBC were significant higher at T3 in RAP group compared to CP group（P=0.01）,and the levels of Hct and Hb,in RAP were significantly higher than those in CP group（P〈0.01,P〈0.05）.Transfusion and volume requirements during operation in RAP group were significantly decreased than CP group（75.0±133.3ml vs.180.0±179.4ml）.No major differences in the duration of mechanical ventilation and total chest tubing drainage between the two groups.CONCLUSION RAP may reduce hemodilution,which could not have a significant damage effect on blood components during CPB in single valve surgery.