小儿体外循环重症法洛四联症血液稀释对血栓弹性描记图的影响

Effects of Hemodilution on Thrombelastograph during operation of TOF with CPB

目的探讨小儿体外循环重症法洛四联症(TOF)根治术,两种血液稀释度对血栓弹性描记图(TEG)凝血和纤溶指标的影响。方法20例小儿重症TOF分为两组,每组10例。采用6%羟乙基淀粉液作为血液稀释液,Ⅰ组将血液稀释至红细胞压积(Hct)0.35;Ⅱ组将血液稀释至Hct0.40。观察心肺转流前、肝素化转流后15min、鱼精蛋白拮抗后15min、术后24小时TEG各项凝血指标变化。结果两组TEG术前R、K、a、MA、CL30、CI正常范围。肝素化转流后各项指标稀释显著(P<0.01)。鱼精蛋白拮抗后15min,Ⅰ组TEG各项指标基本在正常范围。Ⅱ组R、MA、CI偏离正常范围。术后24h,Ⅰ组CI综合凝血指数在正常范围。Ⅱ组R、CI仍偏离正常(P<0.05)。结论小儿重症TOF将体外循环前血液稀释至Hct0.35对凝血功能的影响TEG显示是安全的。

OBJECTIVE To analysis the effects of various hemodilution on the Thrombelastograph （TEG） during tetralogy of fallot （TOF） radical operation . METHODS 20 cases severe TOF childran according to degree of hemodilution were divided into two groups ： Ⅰ group（ Hct 0.35） and Ⅱ group（ Hct 0.40）. used 6% hespander as hemodilution liquid. At preoperation,15min after heparinization,15min after protamine neutralizing,and 24 hours postoperation TEG and parameters of blood coagulate were recorded. RESULTS At preoperation TEG and each parameter of blood coagulate were normal in two groups. At 15min affer heparinization they were changed due to hemodilution. At 15min after ptotamine neutralizing and 24 hours postoperation, TEG and parameters of blood coagulate returned to normal in Ⅰ guoup , but still unnormal in Ⅱ group. CONCLUSION During operation of TOF with CPB the Hct 0.35 for hemodilution is safe and suitable.