儿童体外循环心脏直视手术术中成分输血与术后预后的关系  

Relationship Between Blood Product Transfusion and Post-operative Prognosis in Children With Pediatric Open Heart Surgery by Cardiopulmonary Bypass

作　　者：王亮[1] 陈贝贝[1] 崔洁[1] 刘立飞[1] 徐红珍[1] 唐文[1] 

机构地区：[1]重庆医科大学附属儿童医院麻醉科儿童发育疾病研究教育部重点实验室儿科学重庆市重点实验室重庆市儿童发育重大疾病诊治与预防国际科技合作基地,重庆市400014

出　　处：《中国循环杂志》2015年第8期790-794,共5页Chinese Circulation Journal

摘　　要：目的:探讨体外循环(CPB)心脏直视手术患儿术中成分输血与术后预后的关系。方法:回顾性分析1 028例接受CPB心脏直视手术患儿的临床资料,采用单因素分析及多元Logistic回归分析探讨术中成分输血与术后院内死亡及并发症的关系。结果:1 028例患儿中,术后院内死亡45例(4.4%),发生低心排血量综合征143例(13.9%),急性肾功能衰竭43例(4.2%),肺衰竭26例(2.5%),感染17例(1.7%),神经系统并发症28例(2.7%)。多元Logistic回归分析显示,术后院内死亡的独立危险因素为CPB时间、CPB最低温度、术后24 h儿童死亡风险(PRISM-Ⅲ)评分及术中红细胞输注量>中位输注量(20.3 ml/kg),而术后并发症的独立危险因素为紫绀型先天性心脏病、CPB时间、术后24 h PRISM-Ⅲ评分、术后6 h纵膈引流量及术中红细胞输注量>20.3 ml/kg。结论:儿童CPB心脏直视手术中输注大量红细胞增加术后院内死亡及并发症风险,减少术中红细胞输注可能会改善先天性心脏病儿童的术后预后。Objective： To explore the relationship between intra-operative blood product transfusion and post-operative prognosis in children with pediatric open heart surgery by cardiopulmonary bypass （CPB）. Methods： A total of 1028 consecutive pediatric patients received the open heart surgery by CPB in our hospital were retrospectively studied. Uni- and multivariate Logistic regression analysis were conducted to analyze the relationship between intra-operative blood product transfusion and post-operative in-hospital death and complication rates. Results： There were 45/1028 （4.4%） of patients died, 143 （13.9%） with low cardiac output syndrome, 43 （4.2%） received dialysis, 26 （2.5%） with sustained pulmonary failure, 17 （1.7%） with infection, and 28 （2.7%） developed neurologic complications. Multivariate Logistic regression analysis indicated that duration and the lowest temperature of CPB, 24-hour post-operative pediatric risk of mortality （PRISM-Ill） score and intra-operative transfusion amount of RBC 〉 median （20.3 ml/kg） were the independent risk factors for post-operative in-hospital death. Congenital heart disease （CHD） with pre-operative cyanosis, duration of CPB, 24-hour post-operative PRISM-III score, 6-hour post-operative mediastinal drain loss and intra-operative transfusion amount of RBC 〉 20.3 ml/kg were the independent risk factors for post-operative complication occurrence. Conclusion： Large volume of RBC transfusion in the open heart pediatric surgery with CPB may increase the risk of post-operative in-hospital death and complication occurrence, reducing RBC transfusion might be improving the post-operative prognosis in CHD patients.

关 键 词：输血 并发症 体外循环 儿童 

分 类 号：R457.1[医药卫生—治疗学]