婴幼儿无血心脏手术的可行性分析

The feasibility analysis of bloodless cardiac surgery in infants

目的分析婴幼儿无血心脏手术的可行性及应用价值。方法抽取2015年7月至2016年5月河南省人民医院收治的102例先天性心脏病患儿,根据手术策略不同分为对照组(n=51)和研究组(n=51)。对照组采用常规体外循环与手术方法,研究组采用无血心脏手术策略。比较两组库血用量、不同时间段血气指标(二氧化碳分压、氧分压、BE值、血糖、乳酸值、血红蛋白)及相关临床指标(ICU监护时间、呼吸机辅助时间、24 h引流量)水平。结果研究组血浆输入量及红细胞输入量均少于对照组,差异有统计学意义(P<0.05)。两组术前二氧化碳分压、氧分压、BE值、血糖、乳酸值、血红蛋白水平比较,差异无统计学意义(P>0.05),体外循环20 min、改良超滤结束、术后2 h及术后8 h时研究组血红蛋白水平均低于对照组,体外循环20 min时研究组乳酸值低于对照组,差异有统计学意义(P<0.05),其余时间段各血气指标水平比较,差异无统计学意义(P>0.05)。研究组呼吸机辅助时间较对照组短,24 h引流量较对照组少,差异有统计学意义(P<0.05)。两组ICU监护时间比较,差异无统计学意义(P>0.05)。结论对先天性心脏病患者儿实施无血心脏手术具有可行性及有效性,可节约用血,且不会对患儿围手术期相关指标产生不良影响,有助于患儿及早康复,具有推广价值。

Objective To analyze the feasibility and application value of bloodless cardiac surgery in infants and young children. Methods One hundred and two children with congenital heart disease admitted in People's Hospital of Henan Province from July of 2015 to May of 2016 were selected. According to different surgical strategies,they were divided into control group( n = 51) and study group( n = 51). The control group was treated with conventional extracorporeal circulation and surgical procedures,and the study group was treated with the strategy of bloodless cardiac surgery. Blood transfusion volumes,blood gas indexes( Pa CO2,Pa O2,BE value,glucose,lactic acid,hemoglobin) and other clinical targets( ICU monitoring time,mechanical ventilation time,drainage volume within 24 hours) were compared between two groups. Results The plasma input and red blood cell input in the study group were significantly less than those in the control group,and the difference was statistically significant( P < 0. 05). There was no significant difference between two groups( P > 0. 05) in the levels of Pa CO2,Pa O2,BE value,blood glucose,lactic acid and hemoglobin. The hemoglobin levels in the study group were lower than those in the control group after 20 min of cardiopulmonary bypass,after modified ultrafiltration,2 h and 8 h after operation( P < 0. 05). The level of lactic acid after 20 min of cardiopulmonary bypass in study group was significantly lower than the control group,and the difference was statistically significant( P < 0. 05). There was no significant difference in the blood gas indexes between the other time periods( P > 0. 05). Compared with control group,the mechanical ventilation time was shorter and the drainage volume within24 hours was less in study group,and the difference was statistically significant( P < 0. 05). There was no significant difference between the two groups in the ICU monitoring time.( P > 0. 05). Conclusion The blood heart surgery is feasible and effective in children with congenital heart disease,can reduce blood transfusion,and has no adverse effect on the relevant indicators in perioperative period,contribute to the early rehabilitation of children and has the value of popularization.