小儿腭裂整复术中失血与输液的探讨

The Clinic Study on the Blood Loss and Transfusion in Pediatric Patients with Palatoplasty

目的:就小儿腭裂整复术中如何有效减少失血及合理输液问题进行临床研究,为小儿手术后顺利康复提供依据。方法:选择1.8～14岁“微笑列车”矫治腭裂患儿80例,术中不输血,输注5%葡萄糖、平衡液、血浆代用品—贺斯,分别记录手术开始10、20、30min和术后30min的血压、心率、及血红蛋白、红细胞压积变化并与术前基础值作比较;收集并统计术中失血量,比较用与不用高频电刀作腭部侧切口的失血量,数据均进行统计学处理。结果:围手术期收缩压、舒张压、心率等血流动力学指标变化无显著性差异(P>0.05)。血红蛋白、红细胞压积值均有下降,但术后红细胞压积值均大于30%。用高频电刀作腭部侧切口比不用高频电刀作腭部侧切口的失血量明显减少(P<0.01)。结论:小儿腭裂整复术中合理的输液组合可替代输血,能保证生命征基本平稳,既节约血源,又避免输血可能带来的不良反应;高频电刀作腭部侧切口及电凝止血,是一种高效、安全的止血方法,值得临床推广应用。

Objective： To study how to reduce blood loss efficiently during the operation on the pediatric patient with palatoplasty and to study the rational combination of transfusion, in order to provide a basis for the postoperative recovery in children. Methods： 80 cases without blood-transfusion were selected from the Smile Train, aged from 1.8 to 14 years old. The combination of transfusion during the operation was 5% glucose solution, balance solution and blood plasma substitute HeSi. The intraoperative and postoperative circulation as blood pressure （Bp）, heart rate （HR）, hemoglobulin （Hb）, hematocrit （Hct）, were compared with the preoperative data. The side cut of palate was made by high frequency electricity knife. The amount of blood loss of this method was compared with that of routine method. All data was dealed with statisticaly analyzed. Results： The index of the blood stream dynamics were steady, without obvious difference from the data base （P〉0.05）. The values of Hb and Het descended, but postoperative Het was 30 percent higher. The amount of bleeding of using high frequency electricity knife （HFEK） was obviously reduced （P〈0.01）. Conclusion： During palatoplasty in pediatric patients, the rational combination of transfusion could take the place of blood transfusion and could assure steady of life sign. It could not only save the blood but also avoid the side effects of blood transfusion. The HFEK used for cut was a high effect and safe method of stoping blood. It was good for clinic application.