少血预充体外循环技术对新生儿心脏手术临床结果的影响  

The influence of neonatal bloodless cardiopulmonary bypass on clinical outcomes of neonatal cardiac surgery

作　　者：沈佳[1] 唐嘉忠[1] 张蔚[1] 姜磊[1] 郭铮[1] 朱德明[1] 王伟[1] 杨寅愉[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科体外循环科,上海200127

出　　处：《中国体外循环杂志》2016年第4期209-212,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的回顾分析体外循环节约用血技术在新生儿体外循环中的应用,总结该技术对新生儿心脏手术患者临床结果的影响。方法上海儿童医学中心自2014年1月全面使用新生儿体外循环管道、优化改良超滤方法、自体血液回收及新生儿库血洗涤等多项新技术。选取2013年1月至2015年5月期间于新生儿期行大动脉调转术的患儿共91例,根据手术时间分为两组:2013年1月至12月共38例(A组);2014年1月至2015年5月共53例(B组)。比较两组患者术中用血量、体外循环技术、术后临床结果有无差异及其影响。结果 B组患儿较A组术中用血量明显减少、转流温度趋于浅低温、术毕入ICU即刻乳酸较低、红细胞比容更高,两组间差异具有统计学意义;住院天数及ICU天数组间比较无统计学差异。结论通过对转流管道的改进、超滤方法的优化以及库血洗涤技术在新生儿的应用,明显改善了新生儿期行大动脉转位手术患儿的术中及术后临床指标。Objective This retrospective study is to evaluate the effects of bloodless cardiopulmonary bypass （CPB） on the clinical outcomes of neonatal cardiac surgery. Methods New techniques such as the infant CPB circuit, optimization of modified ultra- filtration （MUF）, autologous blood revoveryand bank blood washing course by cell saver, were used in our centerfrom January 2014. Neonates undergoing Arterial Switch Operation （ASO） from 2013 to 2015 were classified into two groups： Group A included 38 infants who underwent operations in 2013, while Group B included 53 infants who underwent operations in 2014 and 2015. In this study, the bank-stored blood volume used in operation, CPB techniques as well as the clinical outcomes were compared between groups. Results Compared to Group A, patients in Group B required less blood transfusion during CPB whilst more cases used mild hypothermia by- pass, and had lower lactate level and higher hemoglobin value when returned to ICU, but there was no difference in the length of ICU and hospital stay. Conclusion Neonates undergoing ASO had better clinical outcomes with miniaturization of CPB circuit, modifica- tion of MUF method and the technology of autologous blood recovery.

关 键 词：新生儿 大动脉调转术 体外循环 超滤 洗涤库血 自体血液回收 

分 类 号：R726.5[医药卫生—儿科]