库血预处理对婴幼儿体外循环血气指标影响的研究

Study on the influence of preconditioned banked red blood cell on blood gas parameters in infants during extracorporeal circulation

目的 探讨库血（库存悬浮红细胞）预处理对婴幼儿体外循环（ECC）各项血气指标的影响.方法 40例体重10～15 kg、预充液需加入库血、拟在ECC下行简单先天性心脏病矫治手术的患儿,随机分为库血预处理组（P组）和对照组（C组）,每组各20例.P组于ECC预充、排气后将库血1U、肝素1 250 U加入储血罐,水箱38℃保温、血流通气比1∶0.5下行零平衡超滤[以复方电解质注射液（勃脉力A）为洗脱液],超滤出液体300 ml.C组仅在排气结束后将库血加入、混匀不予其它处理.分别于麻醉诱导后（T1）、ECC前（T2）、升主动脉阻断5min后（T3）、停止ECC前（T4）、转入ICU前（T5）五个时点抽取动脉血气,记录各项血气指标：pH、二氧化碳分压（PaCO2）、氧分压（PO2）、碱剩余（BE）、乳酸（Lac）、血糖（Glu）、血钾（K＋）.结果 T1、T3、T4、T5各时点两组患者各项血气指标差异均无统计学意义（P＞0.05）;T2时点P组PaCO2、K＋、Lac、Glu浓度均降低,与C组的差异有统计学意义（P ＜0.05）;T2时点P组的pH、PO2、BE均升高,与C组的差异亦有统计学意义（P＜0.05）.结论 ①库血预处理对降低库血的有害成份,使其各项指标趋近生理化有意义.②库血预处理对改善短时间ECC患儿的酸碱平衡、内环境稳定没有影响.

Objective To observe the influence of preconditioned banked red blood cell on blood gas parameters in infants during extracorporeal circulation （ECC）.Methods Forty patients,undergoing simple congenital heart sugery with ECC were selected and divided randomly into two groups：banked red blood cell preconditioned group （P group） and none-preconditioned group （C group）.In P group,1 unit banked red blood cell and 250 unit heparin were added into the reservoir after ECC priming and evacuating.Water box was kept warm at 38 ℃.Blood flow/ventilation ratio was set at 1∶0.5.300 ml fluid was ultrafiltrated through ultrafiltration.The C group received banked red blood cells infusion into the reservoir directly after evacuating without further processes performed.The arterial blood gas were examined at these time points：after anesthesia induction （T1）,before ECC （T2）,five minutes after clamping the ascending aorta （T3）,before the end of ECC （T4） and before into ICU （T5）.Each parameter of the arterial blood gas was recorded.Results The blood gas parameter at T1,T3,T4 and T5 between two groups were comparable （P ＞0.05）.Compared with that in the C group,PaCO2 and the concentration of potassium,lactate,and glucose in P group were significantly lower （P ＜0.05）,while the PH,PO2 and BE in P group were significantly higher at T2 （P ＜0.05）.Conclusion 1.Preconditioning technique is effectively for decreasing the harmful components in the banked red blood cell.2.But this technique does not show effectiveness in improving the acid-base balance and homeostasis of infants who underwent short time ECC.