自体血预充技术对血液保护作用的研究  

Protective effects of autologous priming technique in cardiopulmonary bypass

作　　者：郑理玲[1] 谢纳新 廖崇先[1] 

机构地区：[1]泉州市第一医院心外科,福建省泉州市362000

出　　处：《中国心血管病研究》2006年第4期260-262,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的研究采用自体血预充技术对体外循环下心脏手术的血液保护作用。方法40例非急诊手术的首次接受体外循环下心脏冠脉搭桥的患者,依性别(男女比例)、年龄、体重、身高、体表面积(BSA)和射血分数(EF)进行配对后分为两组:自体血预充组(n=20)和经典预充组(n=20)。自体血预充组:用1250ml晶体液和8000IU肝素预充,体外循环开始前先采用自体血预充技术置换出大部分最初预充液,维持平均动脉压(MAP)在50mmHg以上。经典预充组:1250ml晶体液和8000IU肝素预充。心肌保护均采用Calafiore温血停跳液灌注。体外循环中保持温度35.0℃～35.5℃,流量2.5～2.8L·min-·1m-2。所有患者按标准手术步骤进行手术。手术结束前将体外循环系统中余血全部回输给患者。结果自体血预充组平均置换出(894±171)ml的最初预充液,患者体外循环中,手术结束时,术后6h、1d、2d的HCT水平均明显高于经典预充组(P<0.05)。自体血预充组围术期人均输血量明显低于经典预充组[(0.16±1.09)U/人和(0.97±2.18)U/人,P<0.05]。自体血预充组患者术后胸腔引流量较经典预充组明显减少(303±89ml和495±112ml,P<0.05)。结论自体血预充技术的应用能减少血液稀释,减少围术期输血量,保护血液。Objective A prospective study has been conducted to evaluate the effects of autologous blood priming in coronary bypass surgery, and compared with standard priming in eardiopulmonary bypass （CPB）, Methods Forty patients undergoing elective coronary artery bypass surgery were matched assigned to CPB with autologous blood priming （A group, n=20） or standard priming （B group, n=20）, The groups were matched for patient＇s sex （male/female）, age, weight, height, body surface area （BSA） and ejection fraction （EF）. A group： The priming of the extracorporeal circuit was crystalloid priming （1250 ml） with beparin （8000 IU ）. Before connection to the intracardiac cannulae, some initial priming was withdrawn from the hard-shell reservoir, The procedure was performed while the patient＇s bemodynamics is carefully monitored. The mean arterial blood pressure was maintained above 50 mmHg. B group： The priming of the extracorporeal circuit was crystalloid priming （1250 ml ） with beparin （8000 IU ）. Myocardial protection was achieved with normothermic intermittent blood cardioplegia according to Calafiore et al. Cardiopulmonary bypass was performed with a temperature of 35.0℃-35.5℃ and flow of 2.5-2.8 L· min^-1· m^-2. All the patients were operated according to standardized surgical protocol. Blood from the bypass circuit was returned to all patients upon the completion of the operation. Results A group had higher hematoerit level during CPB and postoperative time compared with B group （P〈0.05）. With autoIogous blood priming, perioperative transfusion was significantly reduced （10% vs 40%, P〈0.01 ）. The overall mean transfusion volume was higher in patients undergoing standard priming than autologous blood priming （0.16±1.09 units vs 0.97±2.18 units, P〈0.05 ）. Patients in group A demonstrated less mediastinal drainage volume （303±89 ml vs 495±112ml, P〈0.05）. Conclusion Autologous CPB priming technique is an uesful method for the reduction hemodilution

关 键 词：血液灌注 体外循环 心脏外科手术 

分 类 号：R619.9[医药卫生—外科学]