婴幼儿体外循环不同预充液处理方法的对比研究

The research on different processing techniques to priming in infants under cardiopulmonary bypass

目的对比研究婴幼儿体外循环（CPB）心脏手术中不同的预充液处理方法效果及对预后的影响。方法选取5kg以下行CPB心脏直视手术的先心病患婴90例，抽签分为A、B、C3组，每组30例。其中A组在CPB晶体预充排气完毕后加入库血红细胞，对混合预充液进行零平衡超滤（ZBUF）处理；B组使用血液回收机对库血红细胞进行清洗后再加入预充液内；C组在B组方法的基础上，对晶体和清洗后的库血红细胞混合液再行ZBUF，即使用B＋A的方法。3组停机后均行改良超滤（MUF），MUF结束后加入晶体液将部分机血回输体内。对比3组患婴一般情况、混合预充液质量与完成时间、阳-T4的动脉乳酸水平（Lac）、游离血红蛋白（f-Hb）、炎性因子（IL-6／TNF-α）水平、正性肌力药物使用时间、机械通气时间及ICU时间。结果3组患婴一般情况差异有统计学意义。B组与C组Lac、f-Hb、IL-6与TNF-α水平从T1到T4要明显低于A组，P〈0．05，其中C组较B组数值更低但数据尚无统计学差异。B组与C组较A组患婴能明显降低正性肌力药物使用时间、机械通气时间和ICU时间，数据具备统计学差异。结论对于低体质量婴幼儿来说，预充液使血流回收可以较传统ZBUF技术明显优化库血预充环境，节约人力与时间，改善患儿预后。

Objective To explore the effect of different processing techniques to priming and the prognosis in infants dur- ing cardiac surgery under cardiopulmonary bypass （CPB）. Methods 90 cases of pediatric patients under 5kg undergoing CPB open heart surgery were randomly selected, in group A（ n = 30 ） , stored blood was added to the reservoir after erystalloid prim- ing, then zero balanced uhrafihration（ZBUF） for the mixed priming solution; in group B （n = 30） , stored blood was cleaned by cell saver first, then added to the reservoir; in group C（ n =30） , ZBUF technique was combined with cell saver for the priming. Modified ultrafiltration（MUF） was set up afer weaning bypass in all three groups, crystalloid solution was added to the reservoir to replace the residual blood to the patients. The general information, the quality and processing time of the mixed priming solution, the lactate level, free hemoglobin （f-Hb） , inflammatory factor（IL-6/TNF-cL） from TO to T4, the positive ino- tropic drug lasting time, mechanical ventilation time and ICU time were all recorded. Results There were no statistical differ- ences among 3 groups for general condition. The lactate, f-Hb, IL-6 and TNF-α level in B and C group from T1 to T4 was sig- nificantly lower than A group, but no statistical meaning between B and C group. B and C group can significantly reduced the positive inotropic drug lasting time, mechanical ventilation time and ICU time. Conclusion To infants, blood priming pretrea- ted by cell saver can improve the quality of blood protection significantly than traditional ZBUF, also get labor saving and time saving effects, finally improve the prognosis.