婴幼儿体外循环白蛋白预处理对围术期凝血影响的初步研究

Effect of albumin coating of circuit on perioperative coagulation in pediatric paients with congenital heart disease

目的观察体外循环(CPB)下行简单先天性心脏病(CHD)矫治手术的婴幼儿,经白蛋白预处理管路后对其围术期凝血功能的影响。方法选取6个月~2岁,体重5~8 kg,首次在CPB下行CHD矫治手术的40例患儿,随机分为实验组(D组)和对照组(C组),每组20例。D组在CPB管路晶体预充后加入人血白蛋白10 g循环5 min,C组在CPB 5 min后加入人血白蛋白10 g,选取麻醉诱导后(T1)、出手术室前(T2)两个时点,行常规实验室检查测定血常规、高岭土血栓弹力图(TEG)检测凝血功能。记录患儿术前基本资料、CPB时间、主动脉阻断时间、回重症监护室(ICU)后1 h、2 h、4 h的胸引量、围术期血制品用量、肝素化前及CPB改良超滤(MUF)后血红蛋白(Hb)浓度及血小板(Plt)计数。结果 C组患儿回ICU后1 h、2 h胸引量平均值高于D组,但无统计学意义;两组患儿围术期血制品用量无统计学差异。同T1时点相比:T2时点的Plt计数显著降低(P<0.01)且组间比较C组明显低于D组(P<0.05);T2时点的反应时间(R)凝血时间(K)延长(P<0.05),α角、最大振幅(MA)显著缩小(P<0.01),但组间比较无统计学意义。结论经过CPB手术后,简单CHD患儿凝血因子活性减低、血小板功能下降,但大部分在正常范围内;纤维蛋白原功能降低,略低于正常水平;白蛋白预充管路可缓解血小板数量的下降,有减少术后胸引量的趋势。

Objective To observe the effect of albumin coating of cardiopulmonary bypass（ CPB） circuit on perioperative blood coagulation in pediatric patients with congenital heart disease. Methods Fourty patients with congenital heart disease from six months to two years old,were enrolled and randomized into two groups： the control group（ C） and the design group（ D）. The D group received the prime with 10 g albumin for 5 minutes before CPB and the C group received the prime with 10 g albumin 5 minutes after the initiation of CPB. Preoperative demographic data,the chest drainage at 1,2,and 4 hours in ICU,perioperative use of blood were recorded. Kaolin-Activated Thromboelastography and Blood routine were measured after anesthesia induction（ T1） and before leaving the operation room（ T2）. Results The median of chest drainage at 1 hour and 2 hours and transfusion of blood products were similar between the two groups. There was significant difference between the C Group and D Group in platelet count reduction（ P〈0.05）. The value of R（ reaction time） and K（ coagulation time） increased in both groups compared with T1（ P〈0.05）,and the value of α deg and MA（ attainment of maximum amplitude） significantly decreased（ P〈0.01）,but no differences were found between the two groups.Conclusion The platelet count reduction can be mitigated by albumin coating before CPB.There is a trend that pediatric patients treated with albumin coating before CPB output less chest drainage.