低预充体外循环方法对低体重婴幼儿心脏手术影响的初步研究  

Effects of low priming volume during cardiopulmonary bypass on low-weight infants with congenital heart diseases: a prospective single center study

作　　者：王葵亮 曹倩 泮思林 邢泉生 

机构地区：[1]青岛市妇女儿童医院心脏中心,青岛大学先心病研究中心,266034

出　　处：《中国体外循环杂志》2017年第4期193-195,198,共4页Chinese Journal of Extracorporeal Circulation

基　　金：青岛市民生科技计划(15-9-2-69-nsh)

摘　　要：目的通过使用微小化管道和内置动脉微栓滤器膜肺等综合措施,探讨低预充体外循环(CPB)方法对低体重先天性心脏患儿CPB术后恢复的影响。方法收集2016年1月至2016年12月间37例低体重(体重≤5 kg)简单先天性心脏病CPB手术矫治患儿的数据。随机分为两组:实验组(n=20)采用新型整合式膜肺(内置动脉微栓滤器)+3/16英寸微小化管道;对照组(n=17)采用普通膜肺+婴儿型动脉滤器+1/4英寸管道。分别于术前、CPB中5 min、停机时及术后12 h采桡动脉血测定血乳酸值;记录术后机械通气时间;术后监护室停留时间。结果静态预充量和红细胞使用量对照组260~290(272.9±13.1)ml和130~230(171.3±33.3)ml,均高于实验组135~190(160.3±15.2)ml和90~130(111.2±12.9)ml,差别有统计学意义。术中、停机时及术后12 h的血乳酸值实验组分别为<1.0 mmol/L、(1.2±0.5)mmol/L和(1.1±0.3)mmol/L,均较对照组(1.5±0.8)mmol/L、(1.7±0.9)mmol/L和(1.3±0.5)mmol/L低(P<0.05),差别有统计学意义。机械通气时间和在监护室停留时间对照组为(49.6±3.8)h和(6.5±0.5)d,均长于实验组(22.6±2.3)h和(4.5±0.5)d,差别有统计学意义。结论微小化管道和内置动脉微栓滤器膜肺可以有效地减少低体重先天性心脏病患儿CPB预充量和用血量并降低转流过程中的血乳酸水平,更有利于患儿术后恢复。Objective To detect whether the low priming volume cardiopulmonary bypass（ CPB） strategy could improve the postoperative outcome of low-weight infants with congenital heart diseases（ CHD）. Methods From January 2016 to December 2016,a total of 37 consecutive low-weight（ ≤5 kg） infants with simple CHDs in our center received CPB intracardiac surgical treatment.These patients were randomly divided into two groups： experimental group using the 3/16 inch micro circuit and membrane oxygenator with a built-in arterial filter（ n = 20） while the control group using the 1/4 inch circuit and ordinary membrane oxygenator（ n = 17）.The priming aim was to maitain the hematocrit（ Hct） around 25% during CPB. The data were collected as follow,patients characteristics before operations,total priming volume,static priming volume,red blood cell（ RBC） volume,perioperative blood lactate acid concentration and ICU duration. Results The static priming volume,RBC volume of control group were significantly less than those of experimental group（ 160.3±15.2 ml vs 272.9±13.1 ml,111.2±12.9 ml vs 171.3±33.3 ml; P 0.05）. The blood lactate acid concentration during CPB（ 1.0 mmol/L vs 1.5±0.8 mmol/L; P 0.05）,end of CPB（ 1.2±0.5 mmol/L vs 1.7±0.9 mmol/L; P 0.05） and12 h after CPB in experimental group（ 1.1±0.3 mmol/L vs 1.3±0.5 mmol/L; P 0.05） were significantly less than those in control group as well. The ICU duration of experimental group was shorter than that of control group（ 4.5±0.5 d vs 6.5±0.5 d; P 0.05）. Conclusion New CPB strategy using the micro circuit and membrane oxygenator with a built-in arterial filter can reduce priming volume and blood volume effectively. The blood lactate acid concentration of CHD infants with low priming volume decreases and the outcomes are better.

关 键 词：先天性心脏病 低体重 体外循环 低预充 

分 类 号：R726.5[医药卫生—儿科]