先天性心脏病患儿的无血手术治疗

Bloodless surgical treatment of children with congenital heart disease

目的探讨简单属先天性心脏病患儿实施无血手术的可行性,以应对血液资源紧张现状、提高临床科学合理用血水平。方法将57名9～20(16.32±2.08)kg简单属先天性心脏病手术患儿(包括房间隔缺损、室间隔缺损)分为无血(治疗)组(n=25)和输血(对照)组(n=32),比较2组的体外循环时间、阻断时间、术前至术后7 d红细胞比容、术中至术后尿量及胸腔积液引流量、ICU天数、术后住院天数、总住院天数和住院费用。结果 2组手术患儿的体外循环时间、阻断时间、术前至术后7 d红细胞比容、术中至术后尿量及胸腔积液引流量、ICU天数和总住院天数无明显差异(均为P>0.05);术后住院天数:无血组(7.56±1.50)d vs输血组(8.88±2.12)d(P<0.05);住院费用:无血组(28 441.65±2 489.90)元vs输血组(30 189.46±4 892.37)元(P<0.05)。结论 9～20 kg的简单属先心病患儿可在不输注任何血液制品的情况下安全手术,无血手术在一定程度上缩短了这类患儿的住院时间,减少了住院期间花费,值得在先天性心脏病患儿手术治疗中提倡和推广。

Objective To explore the feasibility of the bloodless surgical treatment of children with congenital heart disease, in response to the tense present situation of blood resources, and to improve the use of blood scientifically and rationally. Methods Study in 57 children of 9 - 20kg （ 16.32 ± 2.08 ） kg with congenital heart disease, consist of atrial septal defect and ventricular septal defect, which divided into bloodless group （ n = 25 ） and control group （ n = 32 ） . Preoperative,intraoperative, and postoperative indicators,including cardiopulmonary bypass time, clamping time, hematocrit from preoperation to 7 days after operation, intraoperative, postoperative urine and pleural effusion drainage, ICU days, postoperative days, total hospitalization days and hospitalization costs,were compared in the two groups. Results In the two groups, eardiopulmonary bypass time, clamping time, hematocrit from preoperation to 7 days after operation, intraoperative, postoperative urine and pleural effusion drainage, ICU days, and total hospitalization days were not statistically significant （all P〈0. 05）,but postoperative days：bloodless group （7.56 ± 1.50） days,control group （8. 88 ±2. 12） days （P 〈 0.05） ,and hospitalization costs： bloodless group RMB （28 441.65 ± 2 489. 90）, control group RMB （30 189.46 ± 4 892. 37） （P 〈 0. 05）. Conclusion Children in 9 - 20 kg with congenital heart disease can be safely without use of any blood products for surgical treatment. Bloodless surgical treatment,in a certain extent, shortened the postoperative days, reduced hospitalization costs. It is necessary to advocate and promote bloodless surgical treatment for congenital heart disease in children.