血凝酶对体外循环心内直视术患者血液的保护作用

The Protective Effect of Hemocoagulase on Blood Conservation in Patients Undergoing Intracardiac Surgery under Cardiopulmonary Bypass

目的研究血凝酶对体外循环(CPB)心内直视术患者血液的保护作用。方法将30例室间隔缺损患儿随机分为血凝酶组(n=15)与空白组(n=15)。血凝酶组于麻醉诱导后至CPB前经中心静脉缓慢静注血凝酶1000 U,另1000 U加入预充液中随机转入体内;空白组以等容量生理盐水代替血凝酶。监测2组患儿主动脉阻断时间、CPB时间以及切皮前(T1)、CPB开始后30 min(T2)、鱼精蛋白中和肝素后20 min(T3)、CPB后1 h(T4)的Hb、PLT、PT、APTT、D-dimer;记录术后1、36、h心包纵隔引流量(mL)。结果Hb、PLT值血凝酶组T2、T3、T4显著高于空白组(P<0.05);PT、APTT值血凝酶组值T3、T4显著低于空白组(P<0.01或P<0.05);D-dimer值血凝酶组T2、T3、T4显著低于空白组(P<0.05);心包纵隔引流量2组术后1 h无明显差异(P>0.05),术后3、6 h血凝酶组显著低于空白组(P<0.05或P<0.01)。结论血凝酶对体外循环心内直视术患者血液具有积极的保护作用。

Objective To study the protective effect of hemocoagulase on blood conservation in patients undergoing intracardiac surgery under cardiopulmonary bypass（CPB）. Methods Thirty parvuses suffered from ventricle septum VSD were randomly divided into hemoeoagulase group （n = 15） and control group（n=15）. 1 000 U hemocoagulase was injected into central vein for the patients in hemocoagulase group at the time interval from the anesthesia induction to the begining of CPB,and then another 1 000 U of hemocoagulase was added into priming solution and entered corpore with CPB. Hemocoagulase was replaced with equal volume sodium chloride in the control group. The time of aorta blocking and CPB were monitored. The levels of Hb. PLT, PT, APTT and D-dimer were detected before skin incision （T1）. 30 rains following CPB （T2）. 20 rains post neutralization heparin with protamine （T3） and lhour post CPB（T4） respectively. The drainage volume of arcula cordis and mediastinum were recorded at 1,3,6 h post-operation. Results Compared with the control group, the levels of Hb and PLT increased significantly in the hemocoagulase group（P〈0.05）, with significant decreased levels of PT.APTT and D-dimer at T2 .T3 and T4 （P〈0.05 or P〈0.01）. There was no significant difference between the drainage volume of arcula eordis and mediastinum 1 h post-CPB（P〉0. 05） ,however, 3 h and 6 h post-CPB,the drainage volume of arcula cordis and mediastinum in the hemocoagulase group was significantly lower than that in thecontrol group（P〈0.05 or P〈0.01）. Conclusion Hemocoagulase has significant protective effect on blood conesrvation in patients undergoing intracardiac surgery under cardiopulmonary bypass.