比较两种胶体预充液对婴幼儿心脏直视手术治疗效果的临床研究  

Application of two different colloids priming solution in pediatric patients undergoing cardiac surgery

作　　者：缪娜[1] 杨璟[1] 倪虹[1] 杜中涛[1] 柳薇[1] 李蔚然[1] 李蛟[1] 王征[1] 侯晓彤[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所体外循环科,北京100029

出　　处：《心肺血管病杂志》2013年第2期112-115,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:对比体外循环(extracorporeal circulation,ECC)中6%羟乙基淀粉(HES)130/0.4与3.3%白蛋白(HA)预充对心脏手术患儿围术期血浆胶体渗透压(plasmn colloid osmotic pressure,COP)、液体平衡、肾功能及术后容量治疗的影响。方法:选择美国麻醉医师协会(ASA)Ⅰ-Ⅱ级,5～10 kg患儿行心内直视手术60例,随机分为两组,分别采用6%HES 130/0.4(HES:n=30)和3.3%HA(HA:n=30)进行体外循环预充。观察患儿临床恢复情况、围术期各时点血浆胶体渗透压变化情况、各种液体出入量、出血量和血制品使用情况。结果:HES组ECC预充液、ECC中及手术结束时COP均明显高于HA组(P<0.01);至ICU 6 h,两组COP均恢复至术前水平。ECC中HES组液体总入量明显低于HA组[(2.8±4.1)vs.(6.2±4.4)mL/kg,P<0.01],ECC后HES组输血量明显低于HA组[(27±34)vs.(59±34)mL,P<0.01]。两组血肌酐变化无差异。结论:6%HES 130/0.4能有效维持ECC中COP,减少液体正平衡及减少输血,因此6%HES 130/0.4可以替代3.3%HA于婴幼儿心内直视术ECC中预充使用。Objective：To observe the effect of 6% hydroxyethelstarch 130/0.4（Voluven） and 3.3% Human albumin（HA） as priming solution for plasma colloid osmotic pressure（COP）、body fluid balance,renal function and plasma volume substitution therapy in pediatric patients during cardiac surgery.Methods： 60 ASA I-Ⅱpatients scheduled for congenital heart disease surgery were divided into two equal groups,randomly accepted Voluven（HES group） and 3.3% HA（HA group） as priming solution.Efficacy was evaluated by comparing the hemodynamic paramenters,plasma colloid osmotic pressure,blood loss and allogeneic blood products amount of two groups.Results： COP in priming solution,during and after operation of HES group was much higher than those of HA group（P0.01）.At the appointed time of ICU 6h,COP of two groups was returned to the preoperative level.Compared with HA group,general infusion volume of HES group was much lower during the ECC[（2.8±4.1）vs.（6.2±4.4）mL/kg,P0.01].After operation,the amount of allogeneic blood products of HES group was much lower than HA group[（27±34）vs.（59±34）mL,P0.01].There were no significant differences in serum creatinine.Conclusion： In children undergoing relatively simple cardiac surgery,6% hydroxyethelstarch 130/0.4 may represent alternative to 3.3% HA for priming because it can efficiently maintain the COP and decrease the infusion and transfusion in perioperative.

关 键 词：体外循环 血浆胶体渗透压 胶体溶液 儿童 预充液 

分 类 号：R54[医药卫生—心血管疾病]