小儿先天性心脏病手术中残余机血洗涤回输对凝血功能的影响

Impact of cell salvage during pediatric cardiac surgery on the coagulation

目的了解小儿先天性心脏病手术中残余机血洗涤回输对凝血功能的影响。方法选择2011年11月至2012年5月作者收治的63例先天性心脏病体外循环手术患儿，对其残余机血洗涤回输，输血前后进行血栓弹力图（thromboela-stogram，TEG）检测。结果、所有患儿残余机血回输前血红蛋白（Hb）较转流前显著减少（P〈0．01），回输后显著提高（P〈0．01）。纤维蛋白原（Fib）在残余机血输注前后均较转流前明显下降（P〈0．01），输注后有所上升（P〈0．05）。经肝素酶杯与高岭土杯血栓弹力图（thromboela-stogram，TEG）检查，患儿回输洗涤残余机血前后各有3例存在肝素残留问题，2例回输前无肝素残留，输残余机血后出现肝素残留，残留率为4．8％。与回输前相比，输入后K值、α-Angle、MA值、CI值均无显著差异。结论小儿先天性心脏病术中残余机血洗涤回输对凝血功能无明显影响，并可以明显提高术后血红蛋白水平，是血液保护有效、简便的手段。

Objetive To analyze the impact of of cell salvage during pediatric cardiac surgery on the coagulation. Methods 63 pediatric patients underwent cardiac surgery with cardiopulmonary bypass from November 2611 to May 2012. Residual cardiopulmonary bypass volume was processed by cell saver and transfused after surgery ,and thromboelastography was tested before and after transfusion. Results After bypass haemoglobin concentration notablely decreased （P 〈 0.01 ）. One hour after transfusion of residual circuit volume, haemoglobin concentration increased significantly（P 〈 0. 01 ）. There were three samples indicating heparin residual according to thromboela-stogram, （thromboela-stogram, TEG） measurement before and after transfusion, respectively（4.8% ）. There were no significant differences in K value , α-Angle ,MA value and CI value before and after transfusion of the residual circuit volume. Conclusion Cell salvage of the residual cardiopulmonary bypass volum has little effects on coagulation in pediatric patients. It can notably increase haemoglobin concentration and is a simple and effective method for blood protection.