婴幼儿体外循环心脏直视手术的血液保护策略

Blood conservation strategy in infants undergoing cardiopulmonary bypass during the open heart surgery

在婴幼儿心血管手术中,特别是复杂的先天性心脏病外科手术,血液供需的利弊问题逐渐引起临床的关注。另外异体输血可能会导致传染性疾病的感染,因而如何最大限度地减少术后出血,降低异体血制品的使用频率,同时避免血液破坏是当前亟需解决的热点问题。婴幼儿的凝血系统与成人相比较,其发育尚未成熟,而先心病手术日渐复杂化,这使得维持婴幼儿凝血系统的稳态问题日益突出。本文就当前小儿心脏外科血液保护中的微小化体外循环(CPB)管路、联合超滤技术、负压辅助静脉引流、血液稀释及预充、抗纤溶药物的应用以及自体血液回收的应用进展作一系统性回顾,为完善先心病患儿的血液保护策略提供参考。

In the cardiovascular surgery of infants,especially in complex congenital heart surgery,the advantages anddisadvantages of blood supply and demand have gradually attracted clinical attention.Besides,allogeneic blood transfusionmay lead to the infection of infectious diseases.As a result,how to minimize postoperative bleeding,reduce the usage ofallogeneic blood products,and avoid the damage of blood has become a hot issue for urgent consideration and solution.Theblood coagulation system of infants is not mature compared with adults,and the operation of congenital heart disease isbecoming more and more complex,which makes the issue of maintaining the blood coagulation system of infants becomeincreasingly prominent.This paper provides a reference for perfecting blood conservation strategy of infants with congenitalheart disease,which systematically reviews the application progress of minimized extracorporeal circulation circuits,combined ultrafiltration technology,vacuum assist venous drainage,blood dilution and priming,utilization of antifibrinolyticdrugs,and application of autotransfusion.