体外循环术后异常失血原因分析及防治

目的　探讨体外循环术后异常失血的原因及处理方法。方法　分析374例体外循环心内直视术后纵隔、心包和(或)胸腔失血量。结果　术后纵隔、心包和(或)胸腔失血量>15ml/kg者共45例,占12 .03%。异常失血的原因以术前心功能不全及继发的多脏器功能失调、术中止血不彻底、鱼精蛋白中和不足、深静脉穿刺不当、转机时间过久等多见。结论　术前调整脏器功能,术中细致操作、彻底止血、加强血液保护,术后严密监护、妥善处理、必要时及时开胸止血,是防治术后出血的关键。

Analysis and treatment of abnormal blood loss after cardiopulmonary bypass

Objective To explore the reasons for abnormal blood loss after cardiopulmonary bypass (CPB) and summarize the experience of the treatment.Methods The drainage of pericardium and mediastina and (or) thoracic cavity in 374 patients with cardiopulmonary bypass was retrospectively reviewed. Results Among the 374 cases, there were 45 cases that the drainage dose was more than 15 ml/kg. The blood loss was mainly associated with the cardiac insufficiency before the surgery, the consequent dysfunction of other major organs, insufficient stoppage of bleeding, under dosage of protamine,improper puncture of deep vein, extended time of cardiopulmonary bypass, et al. Conclusion Adjusting the cardiac function in satisfactory status before operation, careful and subtle operation, proper treatment after operation and timely reoperation when necessary are the keys to prevent blood loss after cardiopulmonary bypass.