微小化心肺转流在新生儿及小婴儿先天性心脏病中的应用

Application of minimized cardiopulmonary bypass in neonates and infants with congenital heart disease

目的通过微小化新生儿及小婴儿心肺转流(CPB)管路的长度和直径,探讨该技术对术中悬浮红细胞的用量及临床结果的影响。方法收集2017年1月至2018年6月在CPB下行先天性心脏病手术的新生儿及小婴儿(定义为年龄<3个月或体重<5 kg的婴儿)病例并分为两组,试验组(n=238)采用微小化管路,对照组(n=120)采用普通婴儿型管路。比较两组术中悬浮红细胞用量、术中及术后血细胞比容(HCT)、术后血乳酸、机械通气时间、ICU停留时间、住院时间等。结果两组CPB开始前基本临床资料比较差异无统计学意义(P>0.05)。试验组主动脉阻断后10 min、CPB中及CPB结束后HCT均高于对照组,差异有统计学意义(均P <0.05)。试验组悬浮红细胞用量低于对照组(P <0.05)。试验组术后血乳酸较对照组降低(P <0.05)。两组术后机械通气时间、ICU停留时间、住院时间比较差异无统计学意义(P>0.05)。结论微小化CPB管路能减少新生儿及小婴儿心脏手术中悬浮红细胞的用量,提高术中及术后HCT,降低术后血乳酸水平,达到节约用血目的。

Objective To explore the effect of miniaturization of the length and diameter of cardiopulmonary bypass circuit in neonates and small infants on blood transfusion during operation and the clinical outcomes. Methods From January 2017 to June2018,neonates and small infants( age<3 months or weight<5 kg) who underwent open heart surgery with cardiopulmonary bypass were divided into two groups. Dideco Kids D100 oxygenator,Stockert S5 cardiopulmonary machine,MAQUET BC20 ultrafilter were used in both groups. The experimental group( n = 238) used miniaturized arteriovenous circuit( diameter 3/16 inch),and the control group( n= 120) used ordinary infant arteriovenous circuit( diameter 1/4 inch). Data were collected and compared between the two groups,such as blood transfusion,hematocrit,hemoglobin,blood lactic acid levels,mechanical ventilation time,ICU stay time,hospitalization time,etc. Results There was no significant difference in basic clinical data between the two groups before cardiopulmonary bypass( P >0.05). The hematocrit of the experimental group at three time points( 10 min after aortic cross-clamping,the lowest hematocrit during extracorporeal circulation and after extracorporeal circulation) were higher than those of the control group( P <0.05). The dosage of packed red blood cells transfusion in the experimental group was lower than that in the control group( P <0.05). The lactate level in the experimental group was lower than that in the control group( P <0.05). There was no significant difference in the duration of mechanical ventilation,ICU stay and hospitalization time between the two groups( P >0.05). Conclusion Miniaturized cardiopulmonary bypass can reduce the consumption of packed red blood cells in neonates and infants during cardiac surgery,increase the hematocrit during and after operation,and reduce the blood lactate acid levels after operation,so as to achieve the goal of saving blood.