红细胞储存时间对体外循环心脏直视手术患儿血液指标的影响

Impact of Erythrocyte Storage Duration on Blood Indexes in Children with Open Heart Surgery by Cardiopulmonary Bypass

目的探讨不同储存时间的红细胞对体外循环(CPB)心脏直视手术患儿血液指标的影响,为临床安全输血提供实验室依据。方法回顾性分析2019年1月~2020年7月于我院择期行CPB心脏直视手术的先天性心脏病患儿90例,入选患儿均根据CPB预充所用红细胞储存时间分为新鲜红细胞组(≤14 d,n=49例)和陈旧红细胞组(15~35 d,n=41例)。收集两组患儿手术前后48 h内C^(–)反应蛋白(CRP)、血常规、血电解质、肾功能、心肌酶谱和凝血功能等指标检测结果,观察指标变化并进行统计学分析。结果CPB心脏直视手术后,比较两组患儿手术前后CRP、白细胞计数(WBC)、血红蛋白(HGB)和血小板计数(PLT)、钾离子(K^(+))、钠离子(Na^(+))、氯离子(CL^(–))、钙离子(Ca^(2+))和二氧化碳结合力(CO2)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)及门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH)变化值,差异均无统计学意义(P>0.05)。比较两组患儿凝血酶原时间(PT)、国际标准化比值(INR)和纤维蛋白原(FIB)变化值,差异无统计学意义(P>0.05),但陈旧红细胞组活化部分凝血活酶时间变化值2.00(–1.65,6.90)s较新鲜红细胞组0.00(–4.30,2.90)s明显延长,差异有统计学意义(P<0.05)。结论CPB预充所输不同储存时间的红细胞对CPB心脏直视患儿血液指标未见明显影响,但输注陈旧红细胞的患儿更应注意监测术后凝血功能。

Objective To explore the impact of erythrocyte storage duration on blood indexes in children withopen heart surgery by cardiopulmonary bypass(CPB),and providing laboratory basis for the safety of clinical blood transfusion.Methods A total of 90 consecutive pediatric patients from January 2019 to July 2020 who received the open heart surgery by CPB in our hospital were retrospectively studied.They were divided into the fresher blood group(≤14 d,n=49)and the older blood group(14~35 d,n=41)according to the erythrocyte storage duration.The CRP,blood routine,blood electrolyte level,renal function,myocardial enzymes and coagulation function were collected and their differences were compared between the two groups after 48 hours of surgery.Results After surgery,there were no significant difference between the two groups in the changes of the CRP level,the count of WBC,the HGB level,the count of PLT,the K+,Na^(+),CL^(–)and Ca^(2+)level,the CO2,BUN,Cr and UA level,the AST,LDH,CK,CK-MB andα-HBDH level before and after surgery(P>0.05).There was no significant difference in the changes of PT,INR and FIB between the two groups(P>0.05),but the APTT changes in the older blood group 2.00(–1.65,6.90)s was significantly longer than that in the fresher blood group 0.00(-4.30,2.90)s(P<0.05).Conclusion The results showed that different erythrocyte storage duration has little effect on blood indexes of patients with the open heart surgery by CPB,but it is more important to pay attention to monitor coagulation function changes in the older blood group.