婴幼儿无血心脏直视手术实施策略的研究  

Application of bloodless cardiac surgery strategy in infants

作　　者：葛振伟[1] 赵晖[1] 郎志斌[1] 黄佳鑫[1] 王保才[1] 彭帮田[1] 张岩伟 程兆云[1] 

机构地区：[1]河南省人民医院心血管外科,郑州450003

出　　处：《医药论坛杂志》2016年第8期13-16,共4页Journal of Medical Forum

基　　金：河南省科技发展计划项目基金(132102310190)

摘　　要：目的探讨应用综合策略实施婴幼儿无血心脏直视手术的可行性并对实施无血心脏直视手术的患儿围手术期安全性进行评价。方法自2013年12月至2015年12月共选择6~15kg先天性心脏病（先心病）患儿320名,随机分为2组,对照组（n=160）采用传统体外循环及手术方式,实验组（n=160）实施无血心脏直视手术策略,即使用微型体外循环管路和人工膜肺降低预充量,使用负压辅助静脉引流和改良超滤技术保证术中术后的血红蛋白水平,应用血液回收减少术中血液丢失等综合策略实现无血心脏手术。结果实验组患儿127例成功实施了全程无血心脏直视手术,另外5例于术中加入红细胞,28例于术后在监护室输入红细胞,均无严重并发症发生;33例未成功实施无血心脏直视手术的患儿体重、术前血红蛋白水平、术后24小时引流量与127例成功实施无血手术的患儿有显著差异（P〈0.05）。结论 6~15kg的先心病患儿实施无血心脏手术是安全的,且可以节约用血,围手术期恢复更好。影响成功实施婴幼儿无血心脏直视手术的三大重要因素为：患儿体重、术前血红蛋白水平、术后引流量。Objective To discuss the feasibility of implementing comprehensive strategy to the cardiac surgery in infants without blood transfusion and to evaluate the peri- operative safety of cardiac surgery without blood transfusion in low-weight patients. Methods Three hundred and twenty infants with congenital heart disease（ CHD） in 6 ~ 15 kg were divided into two groups since December in 2013 to December in 2015. In the control group（ n = 160）,all infants were applied with conventional ECC and cardiac surgery; All infants in the experimental group（ n = 160） encounter the strategy of cardiac surgery without blood transfusion. Results Totally 127 cases in the experimental group were succeed in the cardiac surgery without blood transfusion,5 cases in the experimental group input blood cells underwent the heart operation. 27 cases in the experimental group input blood cells in ICU. All cases were successful without serious complications occurred. There are significant differences in body weight,preoperative hemoglobin level,postoperative 24 h drainage volume between 33 cases with unsuccessful implementation and 127 cases with successful implementation in operation. Conclusion It is safe to implement the cardiac surgery without blood transfusion for the 6 ~ 15 kg infants. There is no harmful effect,moreover,the experimental strategy can not only save blood but also has better postoperative recovery.The three key factors which influence the implementation of the cardiac surgery without blood transfusion were the body weight,preopertive hemoglobin and postoperative drainage volume.

关 键 词：体外循环 婴幼儿 节约用血 心脏手术 

分 类 号：R654.2[医药卫生—外科学]