心脏手术后重度机械性溶血再次体外循环手术中血浆置换  

Plasma Exchange for Severe Haemolysis During Re-Cardiopulmonary Bypass to Patients with Cardiac Surgery

作　　者：黑飞龙[1] 龙村[1] 马剑[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院体外循环科,北京100037

出　　处：《中国胸心血管外科临床杂志》2007年第3期177-180,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的总结心脏手术后发生重度机械性溶血、再次体外循环(CPB)手术期间进行血浆置换(plasma exchange,PE)的临床经验。方法2001年1月至2005年12月,对5例严重机械性溶血患者在CPB支持期间进行了PE,其中3例为心瓣膜置换术后发生瓣周漏和感染性心内膜炎;1例为肺动脉瓣狭窄、右心室流出道疏通不满意;1例为体外膜式氧合(ECMO)期间出现严重血液破坏。结果5例患者置换液中血浆用量2.2±0.8L,输血量0.6±0.3L,置换血浆量3.9±1.8L,超滤液量2.4±1.3L。所有患者水电解质和血气分析均维持在正常水平,血流动力学稳定,心脏复苏后顺利停CPB;术后超声心动图复查提示:瓣周漏消失,右心室流出道疏通满意,术后24h内拔除气管内插管,术后第12～53d痊愈出院,尿液清亮,体温恢复正常。3例患者出院前测定游离血红蛋白(FHb),除1例FHb轻度增高(68mg/L)外,其它2例FHb均<40mg/L。结论在CPB期间进行PE是一项安全的技术,其有效的血液净化作用可防治心脏手术后重度机械性溶血所致的急性肾功能衰竭。Objective To summarize the clinical experience of plasma exchange （PE） during recardiopulmonary bypass （CPB） of patients with severe haemolysis in cardiac surgery. Methods Between January 2001 and December 2005, five patients required PE for severe haemolysis after cardiac surgery. There were periprosthetic leakage and infective endocarditis in 3 patients, congenital heart disease of pulmonary artery stenosis with unsatisfied right ventricular outflow tract patching in 1 patient and thrombosis during extracorporeal membrane oxygenation （ECMO） in 1 patient. They all need blood purification to avoid acute renal failure. Results Five patients were successfully treated with PE during CPB without major complications. The amount of plasma and blood transfused in the 5 patients were 2. 2 ± 0. 8L and 0. 6 ± 0. 3L respectively. The volume of plasma exchange and ultrafiltrate were 3.9± 1.8L and 2.4± 1.3L respectively. The electrolytes and blood-gas analysis in all patients were maintained at the normal levels. The hemodynamics was stable. After heart resuscitation CPB stopped smoothly. Disappearance of periprosthetic leakage and satisfaction of right ventricular outflow tract patching were observed by echocardiograms after operation. Extubation was performed 24h after the operation in 5 patients, and they were discharged 12 to 53 d after the operation with fully recovery. The urine was clear and the body temperature was normal. Before they left the hospital, the concentration of free hemoglobin was tested in 3 patients. The concentration of free hemoglobin was slightly higher in 1 patient （68mg/L）, and normal in 2 patients （〈40mg/L）. Conclusion PE during CPB in severe haemolysis is a safe technique which can effectively prevent acute renal failure caused by severe mechanical haemolysis after cardiac surgery.

关 键 词：血浆置换 机械性溶血 体外循环 

分 类 号：R654.1[医药卫生—外科学]