优化改良超滤用于婴幼儿心脏手术的临床效果研究

Effect of modified ultrafiltration in infant cardiac surgery

目的探讨优化改良超滤技术用于婴幼儿心脏手术的临床效果研究。方法采集解放军第一五三中心医院2015年12月至2016年12月166例8 kg以下在体外循环下行心脏手术的患儿。用随机数字表法分为A、B两组。A组为对照组,采用经典改良超滤;B组为实验组,采用优化改良超滤+回输管道剩余机血。比较两组患者的用血量、红细胞比容及术中、术后的临床结果有无差异。结果 166例患者均顺利完成手术,改良超滤结束后、手术结束后实验组的红细胞比容明显高于对照组(P<0.05);实验组术后重症监护室留置时间、呼吸机辅助时间低于对照组(P<0.05),差异有统计学意义,超滤后实验组患者的红细胞比容在正常范围,基本不再输入异体血,因此实验组超滤后红细胞用量为零。结论优化改良超滤技术+回输管道剩余机血较经典改良超滤技术可减少库血用量,降低异体输血带来的风险,缓解血源紧张的问题,并且缩短机械通气时间、重症监护室留置时间,降低住院费用。

Objective To explore the clinical value of modified ultrafiltration（ MUF） technique in saving blood during extracorporeal circulation in infants. Methods Cardiac surgery was performed under extracorporeal circulation for 166 infants under 8 kg from December 2015 to December 2016. The infants were randomly divided into group A and group B,while group A is the control group with conventional ultrafiltration and classic improved ultrafiltration,group B is experimental group with MUF. The hematocrit,ultrafiltration volume,blood transfusion,residual blood volume,ventilation assist time,postoperative intensive care unit length of stay were measured in different groups. Results There was no statistical difference in hematocrit between the two groups. The total amount of hematocrit and ultrafiltration volume in the experimental group were significantly higher than those in the control group,while the blood transfusion,ventilation time,intensive care unit length of stay were lower than the control group. Conclusion MUF technique and autologous blood salvage can reduce the amount of blood transfusion,improve the stability of hemodynamics in infants after cardiac surgery,shorten the intensive care unit stay time,and may reduce hospital costs.