婴幼儿无血体外循环实施策略的研究

目的探讨应用综合策略实施婴幼儿无血体外循环的可行性并对其围术期的安全性进行评价。方法自2013年11月至2014年5月共选择6~14 kg先天性心脏病患儿80名,随机分为2组,对照组(n=40)采用传统体外循环方式,实验组(n=40)实施无血体外循环策略。结果实验组患儿全部成功实施了无血体外循环,其中有33例实现了全程无血心脏手术,无严重并发症发生。围术期实验组血红蛋白浓度明显低于对照组(P0.05),但均在安全范围;体外循环20 min时乳酸值实验组显著低于对照组(P0.05);术后呼吸机辅助时间实验组显著短于对照组(P0.05);24 h引流量实验组显著少于对照组(P0.05),ICU停留时间无明显差异。结论对于体重和血红蛋白浓度合适的患儿实施无血体外循环是安全的,对患儿围术期无不良影响,且可以节约用血,可以避免库血对患儿的不良影响,更有利于患儿的康复。

Application of bloodless cardiopulmonary bypass strategy in infants

Objective To discuss the feasibility of implementing comprehensive strategy of the extracorporeal circulation （ ECC） without blood transfusion and to evaluate the peri-operative safety of this strategy in low-weight infants. Methods Eighty infants diagnosed as congenital heart disease （ CHD） with 6-14 kg were divided into two groups since Nov. 2013 to May 2014. In the control group （ n=40） , all infants were applied with conventional ECC;All infants in the experimental group （ n=40） encounter the strategy of ECC without blood transfusion. Results All cases in the experimental group were succeed in the strategy of ECC without blood transfusion and 33 cases of them underwent the heart operation without blood transfusion in the whole perioperative period. All cases recovered smoothly without serious complications occurred. Hemoglobin concentration in the experimental group was significantly lower than that of the control group （ P〈0.05） , but still in the safe range. The concentration of lactic acid in experimental group was lower than that of control group （ P〈0.05） at 20 minutes after ECC beginning. The mechanical ventilation time of the experimental group was significantly shorter than that of the control group （ P〈0.05） . The drainage volume within 24 h after operation of the experimental group was less than that of the control group （ P〈0.05） . There was no significant difference between the two groups as to the ICU stay time （ P〉0.05） . Conclusion It is safe to implement the strategy of ECC without blood transfusion for the infants who have appropriate body weight and hemoglobin concentration. There is no undesirable influence on the infants during the perioperative period. The new strategy application in ECC can not only save blood but also reduce allogeneic blood transfusion. Most importantly, it is better for the recovery of the infants.