逆行自体血预充对儿童体外循环术后血液成分和肺功能的影响  

Effect of retrograde autologous priming on blood components and pulmonary function in children after cardiopulmonary bypass

作　　者：李牧[1] 石泉[1] 王玮[1] 王洋[1] 刘国华[1] 郑民[1] 

机构地区：[1]桂林医学院附属医院心胸外科,广西桂林541001

出　　处：《重庆医学》2014年第18期2264-2267,2271,共5页Chongqing medicine

基　　金：广西壮族自治区卫生厅自筹经费科研课题(Z2011199)

摘　　要：目的探讨逆行自体血预充(RAP)对儿童体外循环术后血液成分和肺功能的影响。方法将40例体外循环手术患儿分为RAP组(n=20)和常规预充组(CP组,n=20),分别记录两组患儿的相关指标。结果两组患儿术前各参数比较,差异无统计学意义(P>0.05)。在T2、T3时,RAP组较CP组的RBC计数明显升高(P<0.05);在T3时,RAP组较CP组的WBC计数明显升高(P<0.05);在T2、T3时,RAP组较CP组的Hb及血细胞比容(HCT)明显升高(P<0.05);与CP组比较,RAP组围术期的用血量以及术后机械通气时间明显减少(P<0.05);而两组的游离Hb、纤维蛋白原(Fib)、PLT及D-二聚体比较,差异均无统计学意义(P>0.05);在T4时,CP组较RAP组的IL-6和IL-8明显升高(P<0.05),T4的炎症反应最强烈;在T2、T3、T4时,RAP组较CP组的动态肺顺应性和氧合指数明显升高(P<0.05),而肺泡-动脉血氧分压差明显降低(P<0.05)。结论 RAP用于常规体外循环心脏直视手术可减少预充量,降低血液稀释程度,减少临床血用量,同时可以减轻体外循环术后血液有形成分的破坏并能减轻对肺功能的损伤。Objective To study the effect of retrograde autologous priming（RAP）on blood components and pulmonary function in Children after cardiopulmonary bypass.Methods 40 children patients with cardiopulmonary bypass were randomized divided into the RAP group（n=20）and the conventional priming group（CP group,n=20）.The related indexes were recorded in two groups. Results There were no significant differences in the preoperative parameters between the two groups（P＆gt;0.05）.However,the RBC count was significantly higher at T2 and T3 in the RAP group compared with the CP group（P＆lt;0.05）;the WBC count was significantly higher at T3 in the RAP group compared with the CP group（P＆lt;0.05）and the levels of HCT and Hb at T2 and T3 in the RAP were significantly higher than those in the CP group（P＆lt;0.05）;the perioperative blood transfusion volume requirements and the mechanical ventilation time in the RAP group were significantly decreased compared with the CP group（P＆lt;0.05）;PLT, FHb,Fib and D-dimer had no statistically significant differences between the two groups（P＆gt;0.05）.The levels of IL-6 and IL-8 at T4 in the CP group were significantly increased compared with the RAP group（P＆lt;0.05）,the inflammatory reaction was strongest at T4 .The levels of Cdyn and OI at T2 ,T3 and T4 in the RAP group was significantly increased compared with the CP group（P＆lt;0.05）,but P（A-a）O2 was significantly decreased（P＆lt;0.05）.Conclusion RAP used in the conventional extracorporeal circulation car-diac operation may reduce the priming volume,decrease the hemodilution degree and the amount of clinical blood transfusion,at the same time can alleviate the destroy of blood visible components and the damage of the pulmonary function.

关 键 词：体外循环 心脏病 逆行自体血预充 血液成分 肺功能 

分 类 号：R726.5[医药卫生—儿科]