紫绀型先心病——围体外循环心脏直视手术血液流变特性的变化

Cyanotic Cogenital Disease——Changes of Blood Rheological Properties by Open Heart Surgery with Extracorpral Circulation

本史测定了11例紫绀型先天性心脏病病例在围手术期的血液流变特性,发现: 1.不论在术前、术中、术后,该类病例的血液粘、弹参数值均远高于ASD、VSD和瓣膜疾患病例,因而造成较大的心脏后负荷。在术后初期,心脏舒缩功能最为低下,过高的粘、弹指标可能成为导致心衰或低排的重要诱因。若在术中或术后以血液粘、弹参数为参考,调整全血和胶体等渗液的输入量,使患者粘、弹参数控制在ASD、VSD患者水平甚至略低,可以改善患者重要器官的灌流。降低心脏后负荷,在效果上相当于增强了心脏舒缩功能,由此可降低心衰或低排发生率。

11 cases of cyanotic congenital heart disease had been observed during perioperative period The results show.A. In all of these patients, the blood viscoelasticity and viscosity are much higher than those of ASD & VSD cases, and must make a very high after-load. The systolic-anddiastolic function of heart, in the first 72 hours of postoperation, is the lowest in perioperation, and high viscoelasticity or viscosity can become a very important factor by which heart failure or low cardiac output syndrome may be brought out. Adjusting the ratio of blood and colloid isotonic solution, referred to blood viscoelasticity or viscosity, and keeping these parameters at the levels of ADS & VSD cases or even a little lower, can improve the blood perfusion to important organs in patients. Because to reduce after-load, in fact, equals to increase the systolic-anddiastolic function of heart, it can be expected, from this way, to reduce the incidence of heart failure or low cardiac output syndrome and improve the prognosis of operation.B. The results of coagulation tests show that the first factor which induces high incidence of thrombosis in patients of cyanotic congenital heart disease should come from blood hyperaggregation instead of hypercoagulation. So, the incidence of thrombosis can be reduced by antithixotropy or antiaggregation. And the troubles induced by anticoagulation would be avoided.