降低体外循环预充量实现低体重成人患者围术期节约用血策略的研究

Application of blood saving strategy in low-weight adults with heart disease during extracorporeal circulation

目的探讨降低体外循环预充量,减少低体重成人患者库存红细胞用量的方法。方法将60例体重在40-60kg的患者随机分为三组：A组（Dideco905膜式氧合器,儿童管道）,B组（希健成人膜式氧合器,儿童管道）,C组（JostraVKMO70000膜式氧合器,成人管道）。观察三组患者实际预充量、复温时间、术中用血例数、ICU 24 h内用血例数、术后带管时间,监测转机前（T0）、转中（T1）、复温（T2）、停机（T3）、ICU 0 h（T4）、ICU 1 h（T5）、ICU 3 h（T6）血气指标。结果三组在复温时间、术后带管时间,术中及术后ICU 24 h内用血量无统计学差异（P〉0.05）。C组预充量大于A,B两组（P〈0.05）。血红蛋白浓度在T1、T2时间点有统计学差异（P〈0.05）,其余各时间点无统计学差异（P〉0.05）,T1、T2时间点进行组间比较,C组低于A、B两组（P〈0.05）。结论通过改良体外循环预充管道,减少了预充液对低体重患者血红蛋白稀释的影响,减少了围术期库存红细胞的应用机率。

Objective To evaluate the effect of decreasing the extracorporeal circulation（ ECC） priming volume for low-weight adults on reducing allogeneic blood transfusion in cardiac surgery. Methods Sixty low-weight adults（ 40-60 kg） were randomly divided into the following three groups： Group A（ Dideco 905 oxygenator,children ECC circuit）,group B（ Xijian adult oxygenator,children ECC circuit）,group C（ Jostra VKMO7000 oxygenator,adult ECC circuit）. Intra and post-operative（ up to 24 hours after ICU administration） transfusion were collected. Rewarming time,priming volume and extubation time were also recorded. The blood gas analysis was performed at the following time points： before ECC（ T0）,after X-clamp（ T1）,rewarming（ T2）,conclusion of ECC（ T3）,arriving at ICU（ T4）,1 h and 3 h after ICU administration（ T5 and T6）. Results There was no significant difference of rewarming time,extubation time and peri-operative RBC transfusion among the three groups（ P 〉0.05）. Compared with group A and B,group C had larger priming volume（ P〈 0.05）. Hemoglobin（ Hb） concentrations at T1 and T2 were lower in group C. Conclusion The application of decreasing priming volume for low-weight adults can mitigate hemodilution and reduce the probability of peri-operative RBC transfusion.