婴幼儿体外循环术中自体血液回收对血液成分及凝血功能的影响

Effects of autologous blood recovery on blood component and coagulation function during cardiopulmonary bypass in infants

目的 探讨体外循环中采用自体血液回收输注后对婴幼儿血液成分及凝血功能的影响.方法 随机将80例患儿分为观察组和对照组,各40例.观察组使用血液回收机,将术中及体外循环机器余血全部回收处理,并于术后6h内回输至患儿体内.对照组不使用血液回收机,术中及体外循环机器余血弃用.收集两组患儿性别、年龄、体重、术中体外循环时间、主动脉阻断时间;术前,术后15 min、24 h、第5天的血红蛋白（Hb）、红细胞压积（Hct）、血小板（PLT）;术前,术后15 min、24 h、72 h凝血酶原时间（PT）、国际标准化比值（INR）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、凝血酶时间（TT）、D-D二聚体（D-D）、纤维蛋白原降解产物（FDP）;术后24 h引流量、围术期异体血使用率、围术期红细胞使用量、术后凝血酶原复合物（PCC）使用率.结果 两组患儿性别、年龄、体重、术中体外循环时间及主动脉阻断时间比较未见统计学差异（P〉0.05）.两组患儿术前Hb、Hct、PLT、PT、INR、APTT、FIB、TT、D-D、FDP比较未见统计学差异（P〉0.05）.两组患儿术后15 min PT、INR、APTT、TT、D-D、FDP与术前比较差异有统计学意义（P〈0.05）;两组患儿术后不同时点PT、INR、APTT、FIB、TT、D-D、FDP组间比较未见统计学差异（P〉0.05）.两组患儿术后15 min的Hb、Hct组间比较差异有统计学意义（P〈0.05）;两组患儿术后24 h、术后第5天的Hb、Hct、PLT与术前比较未见统计学差异（P〉0.05）.两组患儿库血使用率与库血使用量比较差异有统计学意义（P〈0.05）;两组患儿术后24 h引流量和PCC使用率组间比较未见统计学差异（P〉0.05）.结论 小儿心脏体外循环手术后使用自体血液回收,在不同时点的凝血功能指标与不使用自体血液回收相比较无明显差异.使用自体血液回收可明显减少异体血使用率和使用量,且不增加并发症,可在小儿心脏手术中积极应用.

Objective To observe the effects of autologous blood recovery infusion on blood components and blood coagulation in infants during cardiopulmonary bypass. Methods 80 patients were randomly divided into observation group and control group, each group included 40 cases. Blood recovery machine was used in observation group us,all intraoperative and extracorporeal blood in circulation machine was recovered,and infused into the children within 6 hours after surgery. The control group did not use blood recovery machine,intraoperative and extracorporeal residual blood was wasted. The gender,age,body weight,intraoperative circulation time,aorta block time were documented. Hemoglobin（Hb）,hematocrit（Hct）,platelet（PLT）were measured before operation, 15 min,24 h and 5 days after operation. Prothrombin time （PT）,international normalized ratio （INR）,activated partial thromboplastin time（APTT）,fibrinogen（FIB）,thrombin time（TT）,D-D dimmer,fibrinogen degradation product （FDP）were measured before operation,15 min,24 h and 72 h after operation. The drainage volume 24 h after operation, the rate of perioperative use of allogeneic blood, the amount of red blood cells using perioperatively, the rate of postoperative prothrombin complex （PCC） utilization were also measured. Results There were no statistically significant differences in sex,age,body weight,intraoperative circulation time and aorta block time between the two groups （P〉0.05）. There were no significant differences in Hb,Hct,PLT,PT,INR, APTT,FIB,TT,D-D and FDP in the two groups before operation（P〉0.05）. There were significant differences in PT,INR,APTT,TT,DD and FDP in the two groups at each time point 15 min after operation compared with before operation （P〈0.05）. There was no significant difference in INR,APTT,FIB,TT,DD and FDP between two groups（P〉0.05）. There was significant difference 15 min after operation between Hb and Hct in two groups（P〈0.05）. There was no significant difference in Hb,Hct and PLT in the two groups after operation for 24 h and 5 days compared with before operation （P〉0.05）,the difference between groups was not statistically significant （P〉0.05）. There was significant difference between the two groups （P〈0.05）of the rate of using allogeneic blood and the amount of red blood cells using perioperatively. There was no significant difference between the two groups in the postoperative 24 h drainage volume and the PCC use rate （P〉0.05）. Conclusion There is no significant difference in blood coagulation function of autologous blood recovery in children after cardiopulmonary bypass. The use of autologous blood recovery can significantly reduce,and does not increase the complications,this can be actively applied in pediatric cardiac surgery.