新生儿微小化心肺转流策略的临床应用  

Clinical application of miniaturized cardiopulmonary bypass strategy in neonatal open heart surgery

作　　者：吴柯叶 孟保英[1] 周星 张设设 张程 丁以群[1] Wu Keye;Meng Baoying;Zhou Xing;Zhang Sheshe;Zhang Cheng;Ding Yiqun(Department of Cardiothoracic Surgery,Shenzhen Children's Hospital,Shenzhen 518038,China)

机构地区：[1]深圳市儿童医院胸心外科,深圳518038

出　　处：《中国体外循环杂志》2021年第5期265-269,316,共6页Chinese Journal of Extracorporeal Circulation

基　　金：深圳市医疗卫生三名工程项目(SZSM201612003);深圳市医学重点学科建设经费资助(SZXK036);深圳市科创委基础研究面上项目(JCYJ20190809170811489)。

摘　　要：目的总结新生儿心脏直视手术中微小化心肺转流(CPB)管理策略,并探讨其临床可行性和有效性。方法回顾性分析2015年5月至2020年10月于本中心行CPB下心脏直视手术的新生儿(年龄≤28天)共243例,包括传统CPB组(n=55)和微小化CPB组(n=188),进一步分为传统超滤组(n=55)、微小化非超滤组(n=63)和微小化超滤组(n=125),比较三组预充量、无血预充率、超快通道率、红细胞压积(HCT)、术后机械通气时间、ICU时长及住院时长等指标。评价序贯疗法的效果时分为序贯疗法组(n=36)和非序贯疗法组(n=60),比较两组术后12 h和24 h胸引量。结果微小化CPB组的ICU时长明显短于传统CPB组(P<0.05),多因素模型发现微小化CPB与高无血预充率独立相关(P<0.05),但两组其他指标的差异均无统计学意义(P>0.05)。与传统超滤组相比,微小化非超滤组患儿尿量明显更高(P<0.05),但两组在其他指标方面差异无统计学意义(P>0.05)。采用序贯疗法的患儿12 h和24 h胸引量均明显低于未采用序贯疗法的患儿(P<0.05),且分别在3种手术方式中作亚组分析发现结果相似。结论新生儿微小化CPB策略具有可行性,可以减少临床用血、缩短ICU时长,且序贯疗法可以显著降低复杂性手术患儿术后出血量,改善临床结局。Objective To summarize the miniaturized cardiopulmonary bypass(CPB)strategy in neonatal open heart surgery,and to explore its clinical feasibility and effectiveness.Methods We retrospectively analyzed the data of 243 neonates(age≤28 days)who underwent open heart surgery from May 2015 to October 2020.Patients were divided into conventional CPB group(n=55)and miniaturized CPB group(n=188).Priming volume,bloodless priming rate,ultra-fast track rate,hematocrit,mechanical ventilation time and length of ICU stay after surgery were collected.When evaluating the effect of sequential therapy,they were divided into se⁃quential therapy group(n=36)and non-sequential therapy group(n=60).The chest tube output(CTO)at 12h and 24h postopera⁃tively were compared between the two groups.Results The length of ICU stay in the miniaturized CPB group was significantly shorter than that in the conventional CPB group(P<0.05).We found that miniaturized CPB was independently correlated with high bloodless priming rate(P<0.05)in the multivariate models.The urine volume in the ultrafiltration group was significantly lower than that in the non-ultrafiltration group(P<0.05).The 12h and 24h CTO of children who received sequential therapy was significantly lower than that in non-sequential therapy group(P<0.05),and the results were similar in subgroup analysis in the three surgical methods.Con⁃clusion The neonatal miniaturized CPB strategy is feasible,which can reduce the use of blood and shorten the length of ICU stay,and sequential therapy can significantly reduce postoperative bleeding in children with complex surgery and improve their clinical outcomes.

关 键 词：微小化心肺转流 新生儿 心脏直视手术 超滤 目标导向灌注 序贯疗法 

分 类 号：R726.5[医药卫生—儿科]