逆行自体血预充在体外循环心脏瓣膜置换手术中的应用

Protective effects of retrograde autologous priming technique in cardiopulmonary bypass of valve replacement surgery

目的:探讨逆行自体血预充(RAP)对心脏瓣膜置换手术中血液稀释及围术期输血量的影响。方法:将30例心脏瓣膜置换术患者随机分为RAP组和常规预充组,每组15例。常规预充组采用常规晶体预充液预充,RAP组使用患者自身血液替换部分常规晶体预充液。监测体外循环前、中、结束时以及术后1h、3h等各个时间点的乳酸(Lac)和红细胞压积(Hct)水平,并观察两组患者围术期输血量和胸腔引流量。结果:逆行自体血预充能有效减轻心脏瓣膜置换手术中的血液稀释程度,维持术中较高的Hct水平,对机体血液有较好保护作用,有效减少了围术期输血量。结论:逆行自体血预充能有效减轻心脏瓣膜置换手术中的血液稀释程度,维持术中较高的Hct水平,对机体血液有较好保护作用,有效减少围术期输血量。

Objective：To evaluate the effects of retrograde autologous blood priming （RAP） on hematocrit val- ues and perioperative homogeneous blood transfusions requirements in valve replacement surgery. Method： Thirty patients were randomized divided into two groups： RAP （n~ i5） and standard priming control （n= 15）. Retro- grade autologous priming was performed after insert arterial cannula, blood was allowed to flow back to replace the prime volume with the patient＇s blood. All the patients were operated according to standardized surgical proto- col. Blood from the bypass circuit was returned to all patients upon the completion of the operation. Patientrs blood samples were obtained and Hct. Lac were analyzed at several time points： before CPB, 15 minutes after CPB, CPB end, 1 h, 3 h after operation. The numbers of packed red blood cell transfused during operation and af- ter operation were calculated, chest drainage and bank blood：transfusion was recorded. Result： Hct value in RAP group were significantly higher and Lac in RAP group were significantly lower than those in the standard priming control group at time 15 minutes after CPB, CPB end, and 1 h, 3 h after operation （P〈0.05）. Perioperative chest drainage and blood transfusion in RAP group were significantly lower than those in the standard priming con- trol group （P〈0.05）. The value of priming volume reduction in RAP group were significant （P〈0.01）. Conclu- sion：Retrograde autologous prim!ng （RAP） is a blood conservation technique used to limit the severity of hemodi- lution during cardiopulmonary bypass and reduce perioperative transfusions.