两种超滤方法处理体外循环后余血的对照研究

A comparative study of two ultrafiltration methods in the treatment of residual blood after cardiopulmonary bypass

目的观察两种超滤方法处理体外循环后余血的效果及对患者的影响,为选择合理的回输模式提供参考依据。方法将50例择期体外循环心脏手术患者,随机分为超滤血袋组和环路组。血袋组(n=25):用冷停搏液灌注袋、超滤器、6 mm连接管路、6×6接头、废液袋组成血袋超滤装置,将体外循环后余血经血袋离线超滤后回输;环路组(n=25):用氧合器及储血室旁路之间的超滤装置,将体外循环后余血经超滤后回输。比较两组患者处理机器余血量、超滤处理前后的血红蛋白(Hb)、红细胞压积(HCT)、血小板计数(PLT)、总蛋白、白蛋白、纤维蛋白原(FIB)计数、回收血量、术后24 h内悬浮红细胞输入量、引流量、术后机械通气时间、术后并发症的发生率。结果两组体外循环后余血及回收量,比较差异无统计学意义(P>0.05);血袋组Hb、HCT、PLT、总蛋白、白蛋白、FIB高于环路组,两组比较差异均有统计学意义(P<0.05);两组术后24 h引流及其他临床结果差异无统计学意义(P>0.05);所有患者手术过程及术后恢复顺利,无相关并发症。结论停机后经血袋离线超滤处理的余血Hb、HCT、PLT、总蛋白、白蛋白、FIB浓度较氧合器侧循环超滤更高,其他临床优势需进一步研究证实。

Objective To observe the effect of two ultrafiltration methods in the treatment of residual blood after cardiopulmo⁃nary bypass(CPB)and its influence on patients,so as to provide reference for selecting a reasonable reinfusion mode.Methods 50 patients undergoing elective cardiac surgery with CPB were randomly divided into the blood bag ultrafiltration group and the lateral cir⁃culation ultrafiltration group.The blood bag ultrafiltration group(n=25):a blood bag ultrafiltration device was composed of a blood transfusion bag,an ultrafilter,a 6mm connecting pipeline,a 6×6 joint,and a waste liquid bag.The residual blood after CPB was rein⁃fused after offline ultrafiltration in the blood bag.The lateral circulation ultrafiltration group(n=25):the ultrafiltration device between the oxygenator and the bypass of the blood storage chamber was used,and the residual blood after CPB was subjected to conventional ultrafiltration and transfusd back later.The residual blood volume,hemoglobin(HGB),hematocrit(HCT),platelet count(PLT),to⁃tal protein,albumin,fibrinogen count,recovered blood volume,postoperative input volume and drainage volume of suspended red blood cells within 24 h,postoperative mechanical ventilation time,and the incidence of postoperative complications were compared be⁃tween the two groups.Results There was no significant difference in the amount of residual blood and recovery after CPB between the two groups(P>0.05).HGB,HCT,PLT,total protein,albumin,and fibrinogen in the blood bag ultrafiltration group were signifi⁃cantly higher than those in the lateral circulation ultrafiltration group(P<0.05).There was no significant difference in drainage and other clinical results between the two groups(P>0.05).All patients recovered smoothly during and after surgery without any related complications.Conclusion The concentration of Hb,HCT,PLT,total protein,albumin,and fibrinogen in the residual blood treated by the blood bag ultrafiltration device after CPB are higher than those in the lateral circulation ultrafiltration,and other clinical advanta⁃ges need to be confirmed by further research.