室间隔缺损手术中减少手术输血的安全性研究  

Study on the safety of surgical transfusion in reducing ventricular septal defect in children with congenital heart disease

作　　者：李延军[1] 杜德禄[1] 李俊杰[1] 刘罡[1] Li Yanjun;Du Delu;Li Junjie;Liu Gang(Department of Cardio Thoracic Surgery,Xinxiang Central Hospital,Xinxiang 453000,Henan Province,China)

机构地区：[1]新乡市中心医院心胸外科,河南新乡453000

出　　处：《中华实用儿科临床杂志》2020年第1期36-40,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨室间隔缺损手术中减少手术输血对患儿输血量、安全性和并发症的影响。方法选择新乡市中心医院2018年1月至2019年6月行室间隔缺损修补手术的患儿72例,男38例,女34例;年龄4~10岁。采用随机数字表法分为减少输血组和对照组,每组各36例。减少输血组:(1)麻醉后根据血压情况经中心静脉缓慢放血5 mL/kg,储存入专用枸橼酸抗凝储血袋置4℃恒温冰箱中保存;(2)从切皮开始严密止血,锯开胸骨止血后,全身肝素化,回收创面出血,使用自体血回收装置;(3)尽量缩短体外循环管路,术中红细胞比容(Hct)在0.18~0.20以上不输注红细胞,停体外循环后,回输膜肺及管道余血;(4)术中足量使用抗纤溶药物,鱼精蛋白中和后使用自体血回收装置回收血液;(5)应用止血药物和止血材料;(6)术后入住重症监护室(ICU)后控制血压在适当水平,避免血压过高引起出血,避免盲目补液,减少不必要的血液稀释;(7)术后早期鼓励患儿下床活动,改善患儿胃肠道活动,以达增强营养的目的。对照组:(1)不常规术前预备自体血;(2)主动脉插管前全身肝素化;(3)常规体外循环装置;(4)ICU常规治疗。对2组患儿一般情况、红细胞输注率、平均红细胞用量、术中失血量、术后引流量、手术时间、脱离呼吸机时间、ICU停留时间、住院时间、住院费用、肺部感染率、二次气管插管率、二次手术率、转中胶体渗透压(COP)及转中、术前、术后、出院时血红蛋白量、Hct等进行比较。结果72例患儿均顺利康复出院,减少输血组红细胞输注率为22.22%(8/36例),对照组红细胞输注率为83.33%(30/36例),2组比较差异有统计学意义(χ2=93.12,P<0.05)。减少输血组红细胞用量为(1.56±0.68)U,对照组红细胞用量为(4.26±1.12)U,2组比较差异有统计学意义(t=1.18,P<0.05)。减少输血组术后失血量、术后引流量、术后住院时间、住院费用少于对照组,2组比较差异Objective To investigate the effects of reducing blood transfusion in ventricular septal defect surgery on the volume of blood transfusion,safety and complications of children.Methods A total of 72 children aged 4-10 years who underwent ventricular septal defect repair at Xinxiang Central Hospital between January 2018 and June 2019 were recruited in the study(38 males,34 females).The patients were randomly divided into reduced transfusion group(36 cases)and control group(36 cases)in accordance with the random number table.Reduced transfusion group:(1)after anesthesia,5 mL/kg of blood was drained from the central vein based on blood pressure and stored in a special citric acid anticoagulant blood storage bag which was then put into a 4℃refrigerator.(2)hemostasis was performed strictly from skin incision,and after sternum was sawed,the whole body was heparinized,wound bleeding was recovered,and autologous blood recovery device was used.(3)the extracorporeal circulation pipeline was shortened as far as possible,and in case of the intraoperative hematokrit(Hct)of above 0.18-0.20,no red blood cells were transfused.After stopping the extracorporeal circulation,the remaining blood from the membrane lung and pipeline was transfused back.(4)antifibrinolytic drugs were adequately used during operation,and autologous blood recovery device was used to salvage blood after protamine neutralization.(5)hemostatic drugs and hemostatic materials were used.(6)after admitted to intensive care unit(ICU)postoperatively,the blood pressure was controlled at an appropriate level,to avoid bleeding caused by high blood pressure.Blind rehydration should be also avoided,and unnecessary blood thinning should be reduced.(7)encouraging children to get out of bed early after surgery,so as to improve the gastrointestinal activity of children,thus enhancing nutrition.Control group:(1)unconventional preoperative preparation of autologous blood;(2)systemic heparinization before aortic intubation;(3)conventional extracorporeal circulation device;(4

关 键 词：室间隔缺损 围术期 减少输血 

分 类 号：R726[医药卫生—儿科]