新生儿动静脉同步换血模拟装置的设计与应用

Design and application of arteriovenous synchronous blood exchange simulation device in neonates

目的探讨新生儿外周动静脉同步换血的安全性。方法设计一种用于新生儿外周动静脉同步换血前预测患儿血容量变化的模拟装置,在模拟装置启动前用2袋生理盐水预冲2台输液泵的输血器管路,然后连接3袋生理盐水,同时开启2台输液泵,运行0.5~1 h,开启输液泵前后电子称称量3袋生理盐水的重量,计算动、静脉端流速差异,预估患儿的血容量变化。根据计算结果,在换血时另开一道外周静脉输液补偿通路,以补偿换血过程中的血容量丢失。2018年1—12月13例设为对照组,采用常规外周动静脉同步换血。2019年1—12月11例设为观察组,在外周动静脉同步换血前使用该模拟装置预估患儿血容量变化。结果两组患儿换血效果均理想,但对照组患儿MAP、HR、RR和SpO2在换血45 min后均出现明显波动(均P<0.05),提示该组患儿在换血过程中存在一定程度的血容量变化。与对照组比较,观察组患儿上述生命体征指标均持续稳定,且观察组中无1例患儿出现失血性休克和循环充血的表现,提示该组患儿在换血过程中血液动力学是稳定的,其血容量没有明显变化。结论该装置可精确预测动、静脉端血流速度差异和患儿血容量变化,确保换血过程中患儿血容量稳定,提高新生儿换血的安全性。

Objective To investigate the safety of neonatal peripheral arteriovenous synchronous blood exchange.Methods A simulation device predicting the change in blood volume of children before peripheral arteriovenous synchronous exchange transfusion in neonates was designed.Before the simulation device started,two bags of normal saline were used for pre-flush of the tubes of blood transfusion sets of the two infusion pumps,and then connecting three bags of normal saline,turning on the two infusion pumps at the same time,running for 0.5 to 1 hour;three bags of normal saline were weighed with the electronic scale before and after turning on the infusion pumps,the difference in flow velocity between the artery and vein ends was calculated,and the change in blood volume of children was estimated.According to the calculation results,another peripheral venous infusion compensation path was opened during the exchange transfusion to compensate blood volume loss during the exchange transfusion.From January 2018 to December 2018,13 children who underwent routine peripheral arteriovenous synchronous blood exchange were set as the control group;from January 2019 to December 2019,11 children were set as the observation group,the blood volume change of children was estimated by the simulation device before peripheral arteriovenous synchronous blood exchange.Results The blood purging effect was ideal in both groups,but MAP,HR,RR,and SpO2 in the control group showed significant fluctuations after 45 min of blood exchange(all P<0.05),indicating that there was a certain degree of blood volume change in the group.Compared with the control group,the above vital signs in the observation group were continuously stable,and none of the children in the observation group presented hemorrhagic shock and circulatory congestion,indicating that the hemodynamics of the children in the group were stable during blood exchange,and their blood volume did not change significantly.Conclusion The device can accurately predict the difference in blood flow velocity between the artery and vein ends and the change in the blood volume of children,ensure that the blood volume of the children is stable during blood exchange,and improve the safety of exchange transfusion in neonates.