儿童体外循环心脏手术后甲皱微循环变化的临床观察

Clinical Observtion of NFMC in Pediatric Patients undergoing Cardiac Surgery with CPB

报告３２例先心病儿童体外循环心内直视手术后甲皱微循环变化临床观测的结果。本组病人男１５例，女１７例；年龄１０．６±２．５岁；病种包括ＶＳＤ１２例，ＡＳＤ１５例，ＴＯ１５例。采用中度低温血液稀释非搏动性体外循环［ＣＰＢ］，ＣＰＢ时间５８．５±６．８ｍｉｎ；于术前、术后定时观测甲皱微循环、ＨＣＴ、ＴＰ及ＣＯＰ。结果显示，术中ＨＣＴ、ＴＰ及ＣＯＰ急剧下降（Ｐ＜０．０１），术后甲皱微循环管袢清晰度下降、数目减少，轮廓模糊，红细胞聚集，微血流呈粒流、粒缓流，这些改变于术后３～５天恢复正常。结论认为：ＣＰＢ心脏手术期间及术后早期，影响甲皱微循环的主要因素是血液稀释（ＨＣＴ）、ＣＯＰ、ＰＨ、温度、体外循环灌注损伤、红细胞聚集性增强及药物等；观测甲皱微循环可便捷地了解微循环的形态、流态及微血管周围状态变化的情况，并对临床用药提供参考。

This article reports the results of periodical changes of nail fold microcircu-lation(NFMC)in 32 pediatric patients under-going caedial surgery with cardiopulmonary bypass(CPB).The results showed that there were transient abnormal changes of NFMCin the early stage of postoperation,includingdecteas in clarity and number of blood capil-lary loops(BCL),unusual staxis of theminute blood flow,and fluid ooze from theBCL. We consider that the primary factorscausimg abnormal changes in NFMC arehemodilution(H ct),plasma colloid osmoticpressure(COP), temperature,erythrocyte ag-gregation,drugs and so on. It is beneficial toobsereve the NFMC for leaming the changesof microcirculation and furnishing the refer-ence data on administering drugs.