改良超滤联合血制品序贯输注在新生儿大血管手术中的应用  

Application of modified ultrafiltration combined with sequential infusion of blood products in neonatal cardiovascular surgery

作　　者：刘怀普[1] 梁穗新 孟保英[1] 张程 张维敏 周星 张设设 丁以群[1] Liu Huaipu;Liang Suixin;Meng Baoying;Zhang Cheng;Zhang Weimin;Zhou Xing;Zhang Sheshe;Ding Yiqun(Department of Cardiothoracic Surgery,Shenzhen Children’s Hospital,Shenzhen 518038,China)

机构地区：[1]深圳市儿童医院心胸外科,518038

出　　处：《中华胸心血管外科杂志》2021年第6期326-329,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：深圳市科技计划项目(JCYJ20170303155657876)。

摘　　要：目的探讨体外循环下行大血管手术的新生儿使用改良超滤联合血小板、冷沉淀等血制品序贯输注对其围手术期凝血功能的影响。方法回顾性分析2017年1月至2019年12月行大动脉手术患儿83例,分为对照组(常规超滤,51例)和处理组(改良超滤+血制品序贯输注,32例),比较两组围手术期基本资料、围手术期凝血指标以及术后12、24 h胸腔引流量。结果处理组年龄明显小于对照组(P<0.05);处理组的体外循环明显长于对照组(P<0.01);与术前资料相比,对照组患儿术后活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、国际标准化比值(INR)明显增加,术后血小板计数和纤维蛋白原(FIB)明显降低(P<0.01),而处理组差异无统计学意义。对照组患儿APTT、PT、INR明显增加,术后血小板计数和FIB明显降低(P<0.05);对照组患儿术后12、24 h胸腔引流量明显高于处理组(P<0.01)。结论在新生儿大血管手术中,应用改良超滤联合血制品序贯输注,能够显著改善患儿围手术期凝血功能,减少纵隔出血量。Objective To discuss the effect of modified ultrafiltration combined with sequential infusion of blood products,such as platelets and cryoprecipitation,on perioperative coagulation function in neonates undergoing cardiovascular surgery under extracorporeal circulation.Methods A retrospective analysis was performed on 83 neonates who underwent cardiovascular surgery from January 2017 to December 2019.They were divided into the control group(conventional ultrafiltration,51 cases)and the treatment group(modified ultrafiltration+sequential infusion of blood products,32 cases).Results The age of treatment group was significantly younger than that of the control group(P<0.05).The extracorporeal circulation time of the treatment group was significantly longer than that of the control group.Compared with the preoperative data,post-APTT,post-PT and post-INR were increased significantly in the control group,platelet count and FIB were decreased significantly(P<0.01),while there was no significant difference in the treatment group.Compared with the treatment groups,post-APTT,post-PT and post-INR were significantly increased in the control group,and postoperative platelet count and FIB were significantly decreased(P<0.05).The drainage of control group was significantly higher than that of the treatment group at 12 h and 24 h after surgery(P<0.01).Conclusion The application of modified ultrafiltration combined with sequential infusion of blood products can significantly improve perioperative coagulation and reduce mediastinal bleeding in neonatal after cardiovascular surgery.

关 键 词：新生儿 体外循环 凝血 血制品 

分 类 号：R722.1[医药卫生—儿科]