小儿体外循环机血回输的研究  

Blood re-transfusion after cardiopulmonary bypass in children

作　　者：舒涛[1] 段栩飞[1] 王光辉[1] 王钦文[1] 杨楚墩[1] 江泽熙[1] 

机构地区：[1]武汉市儿童医院胸心血管外科,430016

出　　处：《中华小儿外科杂志》2000年第5期275-277,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的　探讨机血回输指征及其对凝血功能的影响。方法　全组先天性心脏病 5 0例行机血回输 ,其中非紫绀型 48例 ,轻度紫绀型 2例。在围手术期不同的时间 :术前、预充后、转流 3min、30min、60min、90min机血、和术后 3h、2 4h取血液标本 ,测定血浆游离血红蛋白、白细胞、红细胞、血红蛋白、血小板及血球压积。结果　 5 0例全机血回输量 40 0～ 10 0 0ml,平均 70 0ml(P <0 .0 1)。手术用血量 (4 0 0± 2 0 )ml,术后胸引流量平均 110ml,与同期随机抽样 5 0例非紫绀型心脏病患儿相比 ,其用血量 (80 0± 5 0 )ml,胸引流量 130ml,有显著性差异 (P <0 .0 1)。患儿血浆游离血红蛋白随体外循环时间延长而增高 ,90min时达峰值 (2 36 .9± 131.2 )mg/L ,术后 2 4h恢复至正常。结论　①小儿体外循环手术中 ,对血浆游离血红蛋白的监测 ,可以较好地反映出红细胞的破坏情况。转流时间在90min以内者 ,机血回输不影响术后凝血功能及肾功能 ,并可以减少库血用量。②紫绀患儿 ,自身红细胞在氧合情况下较易受到破坏 ,术后机血直接回输应慎重。Objective To search for the possibility of blood re transfusion after cardiopulmonary bypass (CPB) operation on congenital heart disease in children. Methods Fifty patients of congenital heart defects (acyanotic type 48, mild cyanotic type 2) who underwent cardiopulmonary bypass operation were received blood re transfusion from heart lung machine. The volume was from 400 to 1000 ml with an average of 700?ml. The blood samples were obtained before operation, through the priming, 3?min, 30?min, 60?min, 90?min after the starting of CPB, and 3?hr and 24?hr postoperatively to determine plasma free hemoglobin (PF Hb), WBC, RBC, HCT, Hb, and platelet. Fifty cases of acyanotic heart disease who did not received blood re transfusion selected at random were served as control. Results The amount of blood consumed during operation of the blood re transfusion (BRT) group (400±20?ml) was obviously less than that of the controls (800±50?ml, P < 0.001 ). The chest drainage of the control group (130?ml) was more than that of the BRT group (110?ml P < 0.01 ). The PF Hb was increased with the time of cardiopulmonary bypass. It showed a peak reaching of 236.9 ± 131.2 ?mg/L at 90?min and returned to basal levels 24?hr postoperatively.Conclusions Blood re transfusion is an effective method to save blood consumption during open heart surgery in children. PF Hb reflects the features of blood damage during CPB. When cardiopulmonary bypass time within 90?min, the machine blood re transfusion is safety. The red blood cells of patients with cyanotic heart disease were easy damaged during CPB. It should be careful with renal function damage of blood re transfusion.

关 键 词：心肺转流术 体外循环 儿童 血液回输 

分 类 号：R726.1[医药卫生—儿科]