逆行自体血液预充和改良超滤在儿童体外循环中的应用

Effect of Retrograde Autologous Priming and Modified Uitrafdtration on Children's Bypass

目的:探讨逆行自体血液预充技术(RAP)和改良超滤技术(MUF)联合应用对儿童体外循环的影响。方法:40例体外循环手术患儿,随机分为实验组(n=20)和对照组(n=20)。实验组联合应用逆行自体血液预充技术和改良超滤技术,对照组不进行上述两项技术。分别记录两组患儿体重,体表面积。体外循环时间及主动脉阻断时间,逆行自体血液预充置换液量,转前、转中、术后红细胞压积,呼吸机使用时间及围手术期临床用血量。结果:两组患儿体重,体表面积,体外循环时间及主动脉阻断时间差异无统计学意义(P>0.05)。转前、转中红细胞压积比较差异亦无统计学意义(P>0.05);实验组可减少预充液量,转后红细胞压积实验组(32.50±3.04)%高于对照组(24.05±1.47)%,差异具有统计学意义(P<0.05),实验组呼吸机使用时间为(106.50±47.85)min,围手术期临床用血量为(0.15±0.26)U,对照组呼吸机使用时间为(195.75±77.94)min,围手术期临床用血量为(0.78±0.62)u,实验组均少于对照组,差异有极显著性意义(P<0.01)。结论:逆行自体血液预充技术和改良超滤技术在儿童体外循环手术中联合应用可以减少临床用血量,降低输血相关风险,促进患儿术后恢复。

Objective ：To evaluate the effect of retrograde autologous priming（RAP） and modified ultrafiltration（MUF） on children＇s by-pass. Methods ： Forty children undergoing open heart operation were randomly divided into two groups. RAP ＋ MUF group （ n = 20） and control group （n= 20）. The baseline characteristics including body surface area, age, CPB time, and clamp time were recorded. RAP volume, hematocrit （HCT） changes, time of ventilator and transfusion requirements were measured. Results： There were no significant differences between groups with respect to baseline characteristics. HCT before and during bypass were similar. HCT was significantly increased after operation in RAP ＋ MUF group. Time of ventilator（RAP ＋ MUF group 106. 50±47. 85 ,control group 195.75±77. 94 ,P〈0. 01 ） and transfusion requirements（ total donor exposure,0. 15±0. 26 versus 0. 78±0. 62 units,P〈 0.01 ）were significantly lower in the RAP ＋ MUF group. Conclusions ： The combined retrograde autologous priming and modified uhrafihration is an effective method for children＇ s bypass.