微小化体外循环对婴幼儿心脏外科超快通道麻醉的影响  

Effects of mini-cardiopulmonary bypass on ultra-fast track anesthesia of congenital heart disease surgery in infants and young children

作　　者：刘怀普[1] 丁以群[1] 吴柯叶 张青[1] 张程 王元祥[1] 王鹏程 孟保英[1] Liu Huaipu;Ding Yiqun;Wu Keye;Zhang Qing;Zhang Cheng;Wang Yuanxiang;Wang Pengcheng;Meng Baoying(Department of Cardiothoracic Surgery,Shenzhen Children's Hospital,Shenzhen 518026,China)

机构地区：[1]深圳市儿童医院心胸外科

出　　处：《中国体外循环杂志》2019年第3期149-152,共4页Chinese Journal of Extracorporeal Circulation

基　　金：深圳市科创委基础研究自由探索项目(JCYJ20170303155657876);深圳市卫生计划系统科研项目(SZXJ2018044)

摘　　要：目的探讨使用微小化体外循环管道,对婴幼儿心脏外科超快通道麻醉的影响。方法回顾性分析2015年3月至2018年7月行心内直视手术的患儿共1559例,分为传统组(n=541)和微小化组(n=1018)。两组根据体重再分为三个亚组(体重≤4kg组、4kg<体重<8kg组、8kg≤体重≤15kg组)。比较两组预充量、无血预充率、血制品使用量、超快通道率、血红细胞比容及乳酸分析等指标。结果预充量微小化组各亚组明显低于传统组。无血预充率微小化组3个亚组(23.5%、22.9%、80.4%)明显高于传统组(19.6%、10.8%、41.6%)。超滤使用率微小化组(17%)明显低于传统组(94%)(P<0.001)。两组超快通道率无明显统计学差异。结论使用微小化体外循环能够显著减少预充量,提高无血预充率,对超快通道率无明显影响。Objective To analyze the effects of mini-cardiopulmonary bypass on ultra-fast track anesthesia of congenital heart disease surgery in infants and young children.Methods From March 2015 to July 2018, 1559 pediatric patients who underwent open heart surgery were enrolled. Patients were divided into conventional CPB group and mini-CPB group. Prime volume, blood-free priming rate, transfusion, ultra-fast track anesthesia rate, hematocrit and lactic acid levels were collected. Results Prime volume in mini -CPB (weight≤4 kg 80 ml, 4 kg<weight<8 kg 100 ml, 8 kg≤weight≤15 kg 120 ml) group was significantly lower than that in conventional CPB group (250 ml). The blood-free priming rate in mini-CPB group (23.5%, 22.9%, 80.4%)was significantly higher than that in conventional CPB group (19.6%, 10.8%, 41.6%). However, The blood transfusion volume was lower in mini-CPB group, and the use of ultrafiltration was significantly less in in mini-CPB group (94% vs. 17%), either. There was no significant difference in ultra-fast track anesthesia rate (66.4% vs. 58.9%) between the two groups. Conclusion Mini-cardiopulmonary bypass significantly decreased the prime volume and blood transfusion requirement, but showed no significant difference in ultra-fast track anesthesia rate.

关 键 词：微小化体外循环 超快通道 先天性心脏病手术 婴幼儿 无血预充 超滤 心脏外科 

分 类 号：R726.1[医药卫生—儿科]