体外循环术对先天性心脏病儿童围术期凝血功能的影响及临床意义

Study on the clinical significance and effect of cardiopulmonary bypass on intraoperative blood clotting function in pediatric patients with congenital heart disease

目的观察先天性心脏病儿童行体外循环术中凝血功能的变化,并分析其监测的应用价值。方法选取2012年1月至2013年12月间30例先天性心脏病体外循环术患儿为研究组,并且选取同期15例先天性心脏病非外循环术患儿为对照组。观察两组患儿手术前后的凝血功能变化。结果研究组患儿手术前后凝血指标比较差异无统计学意义(P>0.05);研究组患儿术后24 h凝血指标显著低于对照组,差异有统计学意义(P<0.05)。研究组和对照组患儿手术前后凝血指标比较具有明显的变化(P<0.05)。法洛四联症患儿手术后即刻和手术后3 h PLT水平、术后24h FIB水平均显著低于室间隔缺损患儿,差异有统计学意义(P<0.05)。结论临床中采取体液循环术优于传统的非体液循环术,且体液循环术对法洛四联症与室间隔缺损先天性心脏病患儿术中的相关凝血功能指标具有一定的影响,但手术24 h后基本恢复正常。临床中加强凝血功能指标的监测,可以更好地指导临床医师在手术中的操作,从而降低手术的风险。

Objective To observe the changes in intraoperative blood clotting function in pediatric patients with congenital heart disease undergoing cardiopulmonary bypass,and to analyze the significance of its monitoring. Methods A total of 30 pediatric patients with congenital heart undergoing cardiopulmonary bypass during January 2012 to December 2013 were allocated in study group,and 15 pediatric patients with congenital heart disease without undergoing cardiopulmonary bypass in the same period were selected as control group,and the changes in blood coagulation function were observed in patients of these two groups before and after cardiopulmonary bypass. Results The difference in changes of blood coagulation function in patients of study group before and after surgery was not statistically significant（ P 〉 0. 05）. The changes in blood coagulation parameters in patients of study group in 24 h after surgery were significantly lower than those of control group,and the difference was statistically significant（ P 〈 0. 05）. The difference in PLT counts in 3 h after surgery in patients with Fallot’s tetralogy and ventricular septal defect immediately after surgery and 3 h after surgery was statistically significant（ P 〈 0. 05）. The difference in levels of FIB in patients with Fallot’s tetralogy and patients with ventricular septal defect at immediately and 24 h after surgery was statistically significant（ P 〈 0. 05）. Conclusion The application of bypass circulation is better than traditional non- cardiopulmonary bypass in surgical treatment of patients with Fallot’s tetralogy and ventricular septal defect in pediatric patients with congenital heart disease,it had certain impact on coagulation parameters,but they return to normal in 24 h after surgery. It is important to strengthen the monitoring of clinical coagulation parameters,hence it can better guide surgeons in operations,thereby it may reduce the risk of surgery,and it is important to apply in clinical practice.