不同胶体预充策略对体重低于5公斤的先天性心脏病患儿手术预后影响的临床研究  

Clinical study on the effects of different colloid priming strategies on prognosis of pediatric patients less than 5 kg with congenital heart disease

作　　者：周纯[1] 冯正义[1] 童媛媛 崔勇丽[1] 赵明霞[1] 胡金晓[1] 刘凯[1] 赵举[1] 刘晋萍[1] Zhou Chun;Feng Zhengyi;Tong Yuanyuan;Cui Yongli;Zhao Mingxia;Hu Jinxiao;Liu Kai;Zhao Ju;Liu Jinping(Department of Cardiopulmonary Bypass,Fuwai Hospital,National Center of Cardiovascular Disease,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院体外循环中心,北京100037

出　　处：《中国体外循环杂志》2018年第6期324-329,共6页Chinese Journal of Extracorporeal Circulation

基　　金：首都临床特色应用研究专项(Z131107002213172)

摘　　要：目的探索在先天性心脏病(CHD)手术体外循环(CPB)中,用人工胶体完全替代人血白蛋白(HSA)作为胶体预充液对体重低于5 kg的CHD患儿手术预后的影响。方法选取2016年9月至2017年12月在本院行CHD手术体重低于5kg的患儿65例,随机分为两组:人工胶体预充(实验)组(n=33)和HSA复合人工胶体预充(对照)组(n=32)。主要临床终点指标为患儿围CPB期胶体渗透压(COP)。次要临床终点指标包括:围术期肝肾功能指标、术后24 h尿量和胸液量、术后机械通气时间、术后ICU停留时间及住院天数、围术期不良事件发生率和死亡率等。结果两组患儿各时间点COP均无显著差异(P>0.05)。两组患儿术前及术后24 h肝功能指标无统计学差异(P>0.05)。实验组术后24 h尿素氮和尿量均低于对照组(P <0.05)。急性肾损伤评价标准评价术后急性肾功能损伤发生率两组无统计学差异(P>0.05)。术后住院天数实验组明显短于对照组(P <0.05)。两组患儿术后机械通气时间、ICU时间、围术期不良事件发生率及死亡率等无显著差异(P>0.05)。结论在体重低于5 kg的CHD患儿矫治术中,用人工胶体完全替代HSA作为CPB胶体预充液未对患儿手术预后产生不良影响。Objective To explore the effect of complete replacement of human serum albumin with artificial colloid as priming solution during cardiopulmonary bypass on prognosis of pediatric patients less than 5 kg. Methods This was a prospective study,sixty-five pediatric patients less than 5 kg who underwent congenital heart surgery in our hospital from September 2016 to December 2017 were randomly divided into two groups: artificial colloids group( n = 33) and artificial colloids compound albumin group( n = 32). The primary clinical end point was colloid osmotic pressure of the patients during cardiopulmonary bypass. Secondary clinical end points included: postoperative liver and kidney biochemical indicators,urine volume and pleural fluid volume 24 h after operation,postoperative mechanical ventilation time,postoperative ICU stay and hospitalization days,perioperative adverse event rate and mortality rate.Results There was no significant difference in priming colloid osmotic pressure between the two groups at various time points( P< 0.05). The levels of urea nitrogen and postoperative hospital stay in control group were significantly higher than those in experimental group( P <0.05). Urine volume of experimental group was lower than that of control group( P <0.05) 24 h after operation,but AKIN evaluation of acute renal function injury between the two groups showed no significant difference( P >0.05). There were no significant differences between the two groups in duration of mechanical ventilation and the incidence of perioperative adverse events and mortality rate( P >0.05). Conclusion The use of artificial colloids to completely replace human serum albumin as extracorporeal circulation colloidal priming solution did not adversely affect the surgical outcomes of pediatric patients less than 5 kg with congenital heart defects.

关 键 词：体外循环 婴幼儿 人工胶体 胶体渗透压 

分 类 号：R726.5[医药卫生—儿科]