微小化体外循环与超滤对先天性心脏病术后炎症指标的影响  

Effects of miniaturized extracorporeal circulation and ultrafiltration on postoperative inflammation indexes in infants with congenital heart disease

作　　者：提运幸[1] 孟保英[1] 王元祥[1] 张设设 周星 丁以群[1] Ti Yunxing;Meng Baoying;Wang Yuanxiang;Zhang Sheshe;Zhou Xing;Ding Yiqun(Department of Cardiothoracic Surgery,Shenzhen Children's Hospital,Guangdong Shenzhen 518038,China)

机构地区：[1]深圳市儿童医院胸心外科,深圳518038

出　　处：《中国体外循环杂志》2021年第1期22-25,共4页Chinese Journal of Extracorporeal Circulation

基　　金：深圳市卫生计划系统科研项目(SZXJ2018044);深圳市医疗卫生三名工程项目(SZSM201612003)。

摘　　要：目的对比先天性心脏病术中应用微小化体外循环(ECC)策略和超滤对术后婴儿外周血中性粒细胞/淋巴细胞比值(NLR)和C反应蛋白(CRP)变化的影响。方法回顾性分析2015年1月至2018年5月于本院在ECC辅助下行先天性心脏病手术的婴儿共637例,按照术中是否应用微小化ECC策略或常规ECC是否使用超滤分为三组:微小化组(n=359)、超滤组(n=193)和非超滤组(n=85)。收集三组患儿的年龄、性别、体质量、诊断、ECC时间、主动脉阻断时间、术中是否无血预充、转中或停机后是否输注血制品、术中是否应用超滤或微小化ECC策略,围术期外周血中性粒细胞、淋巴细胞和CRP,并进行比较。结果微小化组的无血预充率显著高于超滤组和非超滤组,ECC中用血率明显低于超滤组和非超滤组。停机后血制品输注率各组间比较无明显差异。微小化组和超滤组的术后NLR和CRP均明显低于非超滤组。超滤组术后CRP明显低于微小化组,术后NLR两组间比较无明显差异。结论微小化ECC策略可以降低婴儿先天性心脏病术后NLR和CRP,但降低术后CRP的效果低于超滤。Objective To compare the effect of miniaturized extracorporeal circulation(ECC)strategy and ultrafiltration on the postoperative peripheral blood neutrophil/lymphocyte ratio(NLR)and C-reactive protein(CRP)in infants with congenital heart disease.Methods The data of 637 infants underwent ECC-assisted congenital heart surgery from January 2015 to May 2018 was retrospectively analyzed.Children were divided into three groups:miniaturized group(n=359),ultrafiltration group(n=193)and non-ultrafiltration group(n=85)according to whether intraoperative miniaturized ECC strategy or ultrafiltration was applied.The clinical data of general information,ECC time,aortic cross-clamp time,bloodless priming,blood transfusion during ECC,ultrafiltration or miniaturized ECC strategy during surgery,and perioperative peripheral blood neutrophils,lymphocytes,and CRP were collected and analyzed.Results The proportion of bloodless priming in miniaturized group was significantly higher than that in ultrafiltration group and non-ultrafiltration group.Blood transfusion during ECC in miniaturized group was significantly lower than that in ultrafiltration group and non-ultrafiltration group.There was no statistically significant difference in blood transfusion after ECC among those groups.The postoperative NLR and CRP in the miniaturized group and ultrafiltration group were significantly lower than those in non-ultrafiltration group.The postoperative CRP in ultrafiltration group was significantly lower than that in miniaturized group,the postoperative NLR was not statistically different between the two groups.Conclusion The miniaturized ECC strategy can reduce NLR and CRP in infants with congenital heart surgery,but the effect of reducing CRP is lower than that of ultrafiltration.

关 键 词：微小化体外循环 超滤 先天性心脏病 体外循环 全身炎症反应综合征 

分 类 号：R726.5[医药卫生—儿科]