逆行自体血预充联合改良超滤技术在婴幼儿心脏手术中的应用

Application of retrograde autologous priming combined with modified ultrafiltration in infant cardiac surgery

目的 探讨逆行自体血预充（RAP）联合改良超滤（MUF）技术在婴幼儿心脏手术中的临床应用及意义.方法 选取60例心脏手术婴幼儿,随机分为对照组（n=33）,实验组（n=27）.实验组采用RAP联合MUF方法,对照组按体外循环常规预充.分别观察围术期多时间点的红细胞比容（Hct,T1、T2、T3、T4）及乳酸（Lac）、MUF滤液量、呼吸机辅助时间、住院时间以及术中、术后2h的输血情况.结果 实验组患儿围术期有9例用血,少于对照组的31例,差异有统计学意义（P＜0.05）;实验组术中（T2、T3） Hct明显低于对照组[T2：（25.08 ±0.50）％比（26.81±0.52）％,（P＜0.05],[T3：（26.04 ±0.36）％比（27.79±0.51）％,（P＜0.05].其他观察指标差异无统计学意义（P＞0.05）.结论 RAP联合MUF技术可有效减少婴幼儿血液稀释,满足术中灌注条件,减少围术期用血量.

Objective To explore the clinical application and significance of retrograde autologous priming （RAP） combined with modified ultrafiltration （MUF） in infant cardiac surgery.Methods Sixty pediatric patients with cardiac surgery were selected and randomly divided into the control （n =33） and experimental groups （n =27）.The experimental group was given RAP and MUF,while the control group was only subjected to the conventional method.The situations of hematocrit （Hct,T1,T2,T3,T4） and lactate （Lac） at different perioperative time points,the filtrate volume of MUF,mechanical ventilation time,hospital stay,intraoperative and postoperative 2-h blood transfusion were observed and compared between the two groups.Results The number of patients receiving perioperative blood transfusion in the experimental group （9） was less than that in the control group （31） （P 〈 0.05）.Intraoperative Hct in the experimental group was lower than in the control group [T2：（25.08 ± 0.50） % vs.（26.81 ± 0.52） %,P 〈 0.05;T3：（26.04 ± 0.36） % vs.（27.79 ± 0.51） %,P 〈 0.05].Other indicators showed no significant difference （P 〉 0.05）.Conclusion RAP combined with MUF could effectively reduce hemodilution in pediatric patients,satisfy intraoperative perfusion conditions,and reduce perioperative blood transfusion volume.