体外循环实施无血浆预充策略对小儿心脏术后凝血及临床预后的影响

Impact of priming strategy without fresh frozen plasma on postoperative coagulation and clinical prognosis in pediatric patients after cardiac surgery

目的探索先天性心脏病患儿体外循环中无血浆预充策略对术后凝血功能和临床预后的影响,并分析术后胸液引流量的相关因素。方法回顾性分析阜外医院自2012年1月至2013年4月在体外循环下行先天性心脏病矫治术的患儿资料1 164例,根据年龄及预充液类型分为婴儿血浆组(n=336)、婴儿佳乐施组(n=335)、幼儿血浆组(n=225)和幼儿佳乐施组(n=268)。通过血液学检查、止血药物用量、术后胸液引流量、体外循环及住院期间血制品用量等指标分别对婴儿和幼儿群体评估无血浆预充策略对术后凝血功能的影响,并统计分析不同预充策略组内患儿的住院死亡率及并发症发生率。通过多因素线性回归分析术后胸液引流量的相关因素。结果婴儿佳乐施组、幼儿佳乐施组分别与婴儿血浆组、幼儿血浆组相比,死亡率无显著差异(P>0.05)。婴儿佳乐施组与婴儿血浆组相比,术后12 h及24 h胸液引流量显著增加(P<0.05),但在体外循环及住院期间的血制品使用量显著减少(P<0.05),肺部感染发生率显著下降(P<0.05)。幼儿佳乐施组在体外循环及住院期间的血制品使用量显著少于幼儿血浆组(P<0.05),术后并发症发生率无显著差异(P>0.05)。多因素线性回归分析显示预充液类型、年龄、转机时间与婴儿术后胸液引流量显著相关。结论对于常规择期先天性心脏病矫治术患儿,根据临床指南合理应用人工胶体液替代新鲜冰冻血浆用于体外循环是安全可行的。

Objective To explore the effect of priming strategy without fresh frozen plasma on postoperative coagulation andclinical prognosis in pediatric patients undergoing cardiac surgery and analyze the factors associated with postoperative chest tube drain-age.Methods This is a retrospective study of 1,164 pediatric patients who underwent cardiac surgery with cardiopulmonary bypass（CPB） between January 2012 and April 2013. Patients were divided into four groups：the infants plasma group（n= 336）, the infantsgelatin group（n= 335）,the children plasma group（n= 225）and the children gelatin group（n= 268）. The hematologic data, pharmaco-logical agents, postoperative chest tube drainage and transfusion requirements during CPB and hospitalization were collected to evaluatepostoperative coagulation function. In-hospital mortality and incidence of morbidity were calculated and compared between groups ofdifferent priming strategies. Multiple linear regression analysis was used to explore factors associated with postoperative chest tube drain-age.Results The incidence of mortality were comparable between the plasma and gelatin groups of infants and children（P〉0.05）.Significantly lower incidence of pulmonary infection and more chest tube drainage were demonstrated in the infants gelatin group（P〈0.05）. But requirement of transfusion waslower in the gelatin groups of infants and children（P〈0.05）. Multiple linear regression a-nalysis indicated that the type of prime, age and the bypass time were associated with postoperative chest tube drainage in infants.Conclusion For general pediatric patients undergoing elective cardiac surgery, it is feasible to substitute FFP with gelatin in CPBprime.