逆行自体血预充方法用于心肺转流先心病手术血液保护的效果

The clinicalcomparative study of retrograde autologous priming in congenital heart disease surgery by cardiopulmonary bypass

目的探讨逆行自体血预充技术(RAP)在心肺转流(CPB)先心病手术中的血液保护效果。方法 20例先心病手术患者,随机分为对照组(n=10)和RAP组(n=10)。对照组采用常规的预充方法,RAP组采用逆行自体血预充技术。记录CPB前、CPB 15min、停CPB后1h、术后24h的Hb、Hct和血乳酸(Lac),并记录预充液量、术中用血量、呼吸机辅助时间、ICU停留时间等。结果两组患者均成功进行CPB心脏手术,无患者死亡,无输血相关并发症。RAP组预充液量明显少于对照组(P<0.01)。CPB 15 min和停CPB后1hRAP组Hb和Hct均明显高于对照组(P<0.05);停CPB后1h和术后24hRAP组Lac明显低于对照组(P<0.05)。RAP组围术期用血量明显少于对照组(P<0.05)。结论在CPB先心病手术中使用RAP技术可以有效的减少预充液量,减低CPB过程中的血液稀释,改善组织灌注,减低呼吸机辅助时间,减少术中用血量。

Objective To investigate the clinical application of retrograde autologous priming （RAP）in congenital heart disease surgery by cardiopulmonary bypass.Methods Twenty congenital heart disease patients undergoing heart operation by cardiopulmonary bypass were randomly divided into two groups,group control （n=10）and group RAP （n=10）.Group control was received the regular priming method,whereas group RAP with RAP technique.The hematologic parameters were measured before CPB,15 minutes following CPB,1 h and 24 h after CPB.The priming volume, transfusion requirements,ventilator time and ICU stay time were recorded.Results All patients were healed completely without death and transfusing complications.The priming volume in group RAP was significantly lower than that in group control （P〈0.01）.The levels of hemoglobin and hemato-crit in group RAP at 15 min following CPB and 1 h after CPB were significantly higher compared to group control （P〈0.05）.Lactate in group RAP at 1 h and 24 h after CPB were significantly lower than those in group control （P〈0.05）.The transfusion requirements in group RAP were significantly decreased than group control （P〈0.05）.Conclusion In congenital heart disease surgery by cardiop-ulmonary bypass,RAP technique can effectively decrease priming volume,hemodilution and transfu-sion requirements,improve tissue perfusion and pulmonary function.