摘要
目的比较观察在小儿心脏手术体外循环中使用自体血预充技术与传统预充方式对术后输血量及早期降钙素原水平的影响。方法选择2012年6月-2014年6月在江门市五邑中医院心脏外科拟行先天性心脏病外科手术的60例患儿作为研究对象,按随机原则分为观察组（自体血预充组）和对照组（传统预充组）,每组各30例。两组患儿均采用6%羟乙基淀粉130/0.4预先填充各自管路,对照组转机前不放血,观察组体外循环启动前先采用自体血预充技术置换出大部分最初预充液。治疗期间记录两组患儿术后异体血输入量及血流动力学变化,分别在体外循环前（T0）、术毕回ICU后（T1）、术后第1天（T2）、术后第2天（T3）、术后第3天（T4）5个时间点抽血检验血细胞比容和降钙素原水平。所得数据均采用统计学软件SPSS 20.0进行处理分析。结果 T0、T1、T2时,自体血预充组患儿的血细胞比容水平均明显高于传统预充组,差异均有统计学意义（P〈0.05）：90%自体血预充组患者围术期免于输血,而传统预充组患者未输血比例为60%,差异有统计学意义（P〈0.05）;与T0比较,两组患儿T1、T2、T3和T4血中降钙素原水平均明显升高（P〈0.05）,但组间差异无统计学意义（P〉0.05）。结论自体血预充技术可安全使用于小儿体外循环,且能明显减少术后异体血使用量,值得临床上进一步优化并推广应用。
Objective To compare the influence of autologous priming and traditional priming methods during cardiopulmonary bypass in child cardiac surgery on the rate of blood transfusion after operation and early serum procalcitonin level.Methods 60 patients who intended to do congenital heart disease surgery in the Department of Cardiac Surgery in Wuyi Traditional Chinese Medicine Hospital of Jiangmen City from June 2012 to June 2014 were selected as research objects,they were divided into observation group（autologous priming group） and control group（traditional priming group） according to randomized principle,30 cases in each groups.6%hydroxyethylstarch 130/0.4 was used to prefill pipeline.Control group was not bleed before anesthesia.Autologous priming was used to replace most first priming solution before cardiopulmonary bypass in observation group.Homologous blood transfusion volume and hemodynamic changes after operation of patients in two groups during treatment were record.Levels of hematocrit and serum procalcitonin were tested by hemospasiaing before cardiopulmonary bypass（T0）,the end of operation and back to ICU（T1）,1 day after surgery（T2）,2 day after surgery（T3）,3 day after surgery（T4） in the observation period.All the data was analyzed by statistical software SPSS 20.0.Results Levels of hematocrit at T1 and T2 in autologous priming group were significantly higher than those of the traditional priming group,the differences were statistically significant（P〈0.05）.90%patients of the autologous priming group didn＇t need blood transfusion in perioperative,while 60%patients of the traditional priming group didn＇t need blood transfusion,the difference was statistically significant（P〈0.05）.Compared with T0,serum levels of procalcitonin in two groups were decreased significantly at T1,T2,T3 and T4（P〈0.05）,however,there was no statistical significance between the two groups（P〉0.05）.Conclusion Autologous priming can be safely used in child cardiopulmonary bypass and significantly decrease the used volume of allogeneic blood,and deserves optimization and further application clinically.
出处
《中国医药导报》
CAS
2016年第1期83-86,共4页
China Medical Herald
基金
广东省江门市医药卫生科学技术研究项目(江卫[2013]154-13A048)
关键词
自体血预充
体外循环
输血量
血细胞比容
降钙素原
Autologous priming
Cardiopulmonary bypass
Volume of blood transfusion
Hematocrit
Procalcitonin
