间断热疗在低体质量婴儿体外循环改良超滤期的应用  

Application of a new heat preservation stratagy in low-weight infants during modified ultrafiltration period in cardiopulmonary bypass

作　　者：谢庆 彭勤宝 周成斌 陈晓霞 宋海娟 XIE Qing;PENG Qing-bao;ZHOU Cheng-bin;CHEN Xiao-xia;SONG Han-juan(Department of Cardiac Surgery,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Cardiac Surgery,Nanfang Hospital of Southern Medical University,Guangzhou 510515,China)

机构地区：[1]广东省人民医院(广东省医学科学院)心外科,广州510080 [2]南方医科大学南方医院心外科,广州510515

出　　处：《岭南心血管病杂志》2021年第6期704-707,共4页South China Journal of Cardiovascular Diseases

基　　金：广东省医学科学技术研究基金面上项目(项目编号:A2017364);广东省重点领域研发计划项目(项目编号:2019B020230003)。

摘　　要：目的探讨使用Bair-Hugger充气式升温系统对低体质量婴儿在体外循环改良超滤(modified ultrafiltra⁃tion,MUF)期间实施的有效性与安全性。方法采用前瞻性研究方法,选取2017年1月至2018年6月广东省人民医院收治的1岁以内、体质量5~10 kg、诊断符合先天性心脏病、手术风险分级评分(RACHS-1)为2~3分的患儿共113例,随机分为实验组(M组,n=59)和对照组(C组,n=54)。全组患儿在全身麻醉体外循环下行先天性心脏病矫治术并在同一基线情况下持续行15 min MUF,在MUF期间M组使用Bair-Hugger升温系统以3 min为间隔时长分别使用38℃和43℃交替使用保温,而C组则全程使用38℃保温,其余保温措施相同。记录患儿体外循环结束(T_(1))、MUF后5 min(T_(2))、MUF结束(T3)、手术结束(T_(4))、入重症监护病房即刻(T_(5))共5个时点的鼻咽温(T_(n))及直肠温(Tr),术后患儿皮肤情况、体温异常情况、并发症及术后早期各项恢复指标。结果两组患儿基线资料、术后早期恢复指标比较,差异无统计学意义(P>0.05),均顺利手术并出院。两组患儿鼻咽温和直肠温的比较,在时点T_(1)、T_(4)、T_(5)时差异无统计学意义(P>0.05);在时点T_(2)及T_(3)时M组患儿维持更高的生理温度,与C组比较差异有统计学意义(P<0.05);而术后两组患儿皮肤情况、体温异常情况比较,差异无统计学意义(P>0.05)。两组患儿组内T_(2)时点的鼻咽温和直肠温显著低于T_(1)时点,差异有统计学意义(P<0.05);而两组患儿其余时点间体温比较,差异无统计学意义(P>0.05)。结论对低体质量婴儿而言,MUF实施早期体温下降不可避免,使用Bair-Hugger升温系统在此期间实施间断热疗可较好维持患儿体温,且不增加并发症,值得推广。Objectives To evaluate the effectiveness and safety of using the Bair-Hugger inflatable heating system for low-weight infants during the modified ultrafiltration(MUF)period in cardiopulmonary bypass(CPB).Methods A prospective observational study was conducted on 113 infants with congenital heart disease who were admitted to the Department of Cardiovascular Surgery of Guangdong General Hospital from January 2017 to June 2018.All of them weighed 5 to 10 kg and adjusted for surgical risk correction score(RACHS-1)of 2-3.Before operation,the children were divided into experimental group(M group,n=59)and control group(C group,n=54)by computer pseudo-random numbers after simple randomization.All the children underwent correction of congenital heart disease CPB under general anesthesia and continued to run MUF for 15 min under the same baseline condition.During the MUF period,M group used Bair-Hugger heating system to alternately preserve heat at 38℃and 43℃at intervals of 3 min,while C group used 38℃for the whole process,and other heat preservation measures were the same.Nasopharyngeal temperature(T_(n)),rectal temperature(Tr),skin condition of children after operation and abnormal body temperature condition were recorded at 5 time points including end of CPB(T_(1)),5 min after MUF(T_(2)),end of MUF(T_(3)),end of operation(T_(4))and immediate admission to intense care unite(ICU)(T_(5)).Results There was no significant difference in baseline data,intraoperative conditions and postoperative indexes between the two groups(P>0.05).All the children were successfully operated and discharged from hospital.There were no significant differences in T_(n) and Tr between the two groups at time points T_(1),T_(4) and T_(5)(P>0.05),and M group could maintain higher physiological temperature at time points T_(2) and T3(P<0.01),while there were no significant differences in skin condition and abnormal body temperature between the two groups after operation(P>0.05).Conclusions For low-weight infants,alternating heat preservation th

关 键 词：间断热疗 体外循环 改良超滤 婴儿 

分 类 号：R654.1[医药卫生—外科学]