自体血逆行预充在体外循环中应用的探讨  

Application of retrograde autologous priming in cardiopulmonary bypass

作　　者：杨璟[1] 何美玲[1] 赵岩岩[1] 董培青[1] 

机构地区：[1]首都医科大学附属北京安贞医院体外循环科,北京100029

出　　处：《中国体外循环杂志》2010年第2期83-85,116,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的通过实施自体血液逆行预充(RAP),观察能否有效降低体外循环(CPB)预充量,提高术中Hct,减少术后异体血输入量及改善临床结果。方法患者210例随机分为两组,N1组(RAP组)和N2组(对照组),每组各105例。RAP组在主动脉插管与主动脉管路连接后,开放连接管,使动脉管路中血液缓慢逆行返回,替代出等量的预充液体,存入备用袋中,待膜肺动脉路至主动脉插管处管路完全被血液充满后,钳夹主动脉路。腔静脉插管连接完毕,缓慢开放静脉引流管阻断钳,用静脉血将静脉管路中液体全部替换,同时用泵将等量液体存入备用的袋中。分别监测麻醉后,CPB前(T1)、CPB开始15 min(T2),停CPB后1 h(T3),术后2 h(即返回ICU后2 h,T4)的血红蛋白(Hb)、红细胞比容(Hct)、乳酸(Lac),观察两组患者术中、术后2 h的输血及术后出血量。结果 RAP组通过RAP减少预充液量(795.09±21.6)ml,较对照组明显减少(P<0.001)。RAP组在T2、T3时Hb、Hct明显高于对照组(P<0.05);Lac结果表明,RAP组在T2、T3、T4时明显低于对照组(P<0.05或P<0.001)。术中、术后2 h的输血量RAP组较对照组显著减少(P<0.001)。两组间患者术中及术后出血量无明显差异。结论 RAP方法可以有效地降低血液稀释,明显提高术中Hct水平,改善术中灌注条件,有效地减少术中及术后输血量。OBJECTIVE This study is intended to observe whether retrograde autologous blood priming（RAP） could be used to reduce cardiopulmonary bypass（CPB） circuit priming volume,increase hematocrit values during bypass,attenuate homogeneous blood transfusions requirements and improvement clinical outcomes.METHODS 210 patients were randomized divided into two groups： RAP（N1=105） and control（N2=105）.Retrograde autologous priming was performed after heparin administration（300 U/kg） and before CPB.The process was conducted in 3 steps.After insert arterial cannula,blood was allowed to flow back（by passive pressure gradients） through the arterial line and filter,to replace the prime volume with the patient＇s blood.Next,crystalloid in the venous reservoir and oxygenator was replaced using pump.Finally,prime in the venous line was collected into the blood transfer bag at the onset of CPB.Patient＇s blood samples were obtained at several time points： after anaethesis induction and before cardiopulmonary bypass（T1）,15 minutes after CPB（T2）,1 hour（T3） after CPB,2 hours of ICU（T4）.Hb,Hct,BUN,Lac were analyzed at each time point.The numbers of packed red blood cell transfused during operation and within 2 hours after operation were calculated,chest drainage and bank blood transfusion was recorded.RESULTS The value of priming volume reduction in RAP group were（795.09±21.6） ml（P〈0.001）.Hb,Hct values in RAP group were significantly higher than the control group at timeT2 and T3（P〈0.05）.Lac in RAP group were significantly lower than the control group at time T2（P〈0.05）,T3 and T4（P〈0.001）.Packed red blood cell transfused during operation and within 2 hours postoperatively in RAP group were less than the control group（P〈0.001）.CONCLUSION RAP is a blood conservation technique which could decrease hemodilution,improve outcomes of CPB,and reduce perioperative transfusion volume.

关 键 词：自体血逆行预充 体外循环 心脏外科 

分 类 号：R654.1[医药卫生—外科学]