528例先天性心脏病患儿心内直视手术无血预充体外循环的管理  

Management of Bloodless Priming Cardiopulmonary Bypass in Children Undergoing Open Heart Operation

作　　者：崔洁[1] 姚尧 徐红珍[1] 吴春[2] 儿童发育疾病研究教育部重点实验室 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室 CUI Jie;YAO Yao;XU Hong-zhen;WU Chun(Department of Anesthesiology,Children＇s Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders China International Science and Technology,Cooperation base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing（400014）,China)

机构地区：[1]重庆医科大学附属儿童医院麻醉科,重庆市400010 [2]重庆医科大学附属儿童医院心胸外科,重庆市400010 [3]不详

出　　处：《中国循环杂志》2018年第9期894-899,共6页Chinese Circulation Journal

基　　金：国家临床重点专科建设项目(国卫办医函[2013]544); 重庆医科大学附属儿童医院临床研究项目(lcyj2014-17)

摘　　要：目的:总结先天性心脏病(先心病)患儿心内直视手术无血预充体外循环(CPB)的方法及管理经验。方法:回顾性分析重庆医科大学附属儿童医院2013-11至2016-11收治的先心病528例患儿心内直视手术无血预充体外循环情况。所有患儿均行气管插管全身麻醉,体外循环下完成心内畸形矫治手术,选用改良体外循环管路减少预充量,依据患儿术前红细胞压积(HCT)水平,选用急性等容性血液稀释性自体输血技术,使用血液回收机行回收式自体输血技术减少血液丢失,依据体外循环情况行常规超滤、平衡超滤及改良超滤,实现无血体外循环。结果:528例不同体重患儿的预充量:<5 kg(160~180)ml,5~12 kg(220~250) ml,12~28 kg(300~350 ml),>28kg(600~650)ml;入室后的平均HCT(36.1±5.9)%,实施无血预充,体外循环5 min时HCT(24.3±3.1)%,停机前HCT(24.8±3.0)%,出室前HCT(32.1±3.8)%。其中有43例(8.1%)患儿体外循环过程中输注库存血,停机后有25例(4.8%)患儿输注库血。行急性等容性血液稀释性自体输血的患儿共72例(13.6%),共放血15 520 ml。术中195例复杂先心病患儿中有189例(96.9%)使用血液回收机,333例单纯房间隔缺损、室间隔缺损及合并动脉导管未闭患儿中,仅有3例(9.0%)使用血液回收,且均为稀有血型患儿。体外循环过程中使用常规超滤223例(42.2%),平衡超滤211例(40.0%)及改良超滤247例(46.8%)。结论:小儿先心病手术的无血体外循环有其复杂性及特殊性。对于体重和HCT水平合适的患儿,使用改良体外循环管路,结合急性等容性血液稀释及回收式自体输血、超滤技术,无血预充能够安全地在儿童先心病手术体外循环中实施,从而实现节约用血,减少异体输血的并发症,促进患儿早日康复。Objectives： To summarize the methods and experience of bloodless priming cardiopulmonary bypass（CPB） management of children undergoing open heart operation.Methods： We reviewed the clinical protocols of bloodless priming CPB in 528 children undergoing open heart operation in Children＇s Hospital of Chongqing medical university from November 2013 to November 2016. All cases underwent open heart operation with bloodless priming CPB and general anesthesia. To optimize bloodless priming CPB in children, we selected the modified tubes to reduce priming volume. Based on patients＇ HCT before operation, acute normovolemic hemodilution（ANH） was used before CPB, autologous blood transfusion was used after CPB to reduce blood lose. According CPB conditions, patients underwent conventional ultrafiltration（CUF）, balanced ultrafiltration（BUF） and modified ultrafiltration（MUF） through cell salvage.Results： The priming volume of the 528 children were as follows： 0-5 kg（160-180）ml,5-12 kg（220-250） ml,12-28 kg（300-350） ml,over 28 kg（600-650） ml. The Hct was（36.1±5.9） % after anesthesia and before CPB, was（24.3±3.1） % at 5 minutes after CPB, was（24.8±3.0） % at the end of CPB, and was（32.1±3.8） % before leaving the operating room. 43（8.1%） patients received blood transfusion during CPB and 25（4.8%） patients received blood transfusion after CPB, 17.25 U of blood was used in total. ANH was applied to 72（13.6%）patients before operation. During operation, 189（96.9%） out of 195 complex heart disease patients used cell salvage and 3（9%） patients used cell salvage among 333 simple heart disease patients. The 3 patients were all with rare blood type. Among the 528 patients, 223（42.2%） patients underwent CUF, 211（40.0%） patients underwent BUF and 247（46.8%） patients underwent MUF.Conclusions： The management of bloodless cardiopulmonary bypass in children undergoing open heart operation is complex and requires special attention on individual p

关 键 词：体外循环 儿童 节约用血 

分 类 号：R541[医药卫生—心血管疾病]