摘要
目的在长时间心肺转流(CPB)患者中,对比研究应用微聚体滤器(SQ40s滤器)与普通输血器处理剩余机血与Cellsaver回收血液的临床效果。方法纳入CPB需低温停循环或低流量的成人患者60例,按随机数字表分为实验组(SQ40s滤器,n=30)与对照组(普通输血器,n=30),组内随机分为剩余机血组(n=15)和Cellsaver回收血组(n=15)。主要临床终点指标:扫描电镜滤膜残留物观察。次要临床终点指标:CPB前、CPB停机时、滤过后、术后24 h红细胞、白细胞、血小板及肌酐。术毕及术后1 h、3 h、12 h、24 h的呼吸指数、术后24 h胸腔引流量、机械辅助通气时间、ICU停留时间及住院时间。结果扫描电镜半定量分析,实验组滤膜残留拦截物明显多于对照组[(0.633±0.127) vs (0.245±0.040),P=0.001]。呼吸指数呈现时间效应且实验组患者术后12 h呼吸指数低于对照组(P=0.027),术后24 h肌酐水平明显低于对照组[96.73(89.58～119.04)μmol/L vs 113.93(97.65～153.38)μmol/L,P=0.029]。其他临床指标无统计学差异。结论长时间心肺转流过程中,应用SQ40s微聚体滤器可以拦截回收血液中的微聚体,并对血液成份无影响,潜在改善患者预后。
Objective To compare the effect of residual pump blood processed by microaggregate blood filter or ordinary blood transfusion apparatus in patients＇ recovery. Methods 60 adult patients who received hypothermic circulatory arrest or low flow cardiopulmonary bypass were randomly divided into trial group（ SQ40 s,n = 30） and control group（ transfusion apparatus,n = 30）,patients in each group were randomly divided into two subgroups（ n = 15） ： the residual pump blood group and the cell saver recycling group. The primary endpoint was the filter membrane residues observed by scanning electron microscope. The secondary endpoints were erythrocytes,white blood cells,platelets and creatinine before CPB,at the end of CPB,after the residual blood infusion and 24 hours after the operations. The thoracic drainage,the mechanical ventilation time,the duration of ICU stay and the length of hospital stay were also observed. The respiratory index within 24 hours after operation was recorded dynamically. Results The SQ40 s filter residues in the net were significantly more than those of ordinary blood transfusion apparatus（ 0.633±0.127 vs 0.245±0.040,P = 0.001）. By using SQ40 s to filter the residual pump blood,the creatinine level was significantly lower than that of the control group 24 hours after operation（ 96.73（ 89.58-119.04） vs 113.93（ 97.65-153.38）,P = 0.029）. The respiratory index showed a time effect and it was significantly lower than that in the control group 12 hours after operation（ P = 0.027）. There was no statistical difference in other clinical indexes.Conclusion The SQ40 s filter can reduce the microaggregates in the recycled blood without changing blood components during long time cardiopulmonary bypass and it may improve patients＇ recovery.
作者
刘铭月
李勇男
刘刚
闫姝洁
张巧妮
楼松
吉冰洋
Liu Mingyue;Li Yongnan;Liu Gang;Yan Shujie;Zhang Qiaoni;Lou Song;Ji Bingyang(Department of Extracorporeal Circulation,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,China)
出处
《中国体外循环杂志》
2018年第5期278-283,301,共7页
Chinese Journal of Extracorporeal Circulation
关键词
心肺转流
剩余机血
微聚体滤器
SQ40s
Cardiopulmonary bypass
Residual pump blood
Microaggregate blood filter
SQ40s
