There is increasing concern about the safety of homologous blood transfusion during cardiac surgery,and a restrictive transfusion practice is associated with improved outcome.Transfusion-free pediatric cardiac surgery...There is increasing concern about the safety of homologous blood transfusion during cardiac surgery,and a restrictive transfusion practice is associated with improved outcome.Transfusion-free pediatric cardiac surgery is unrealistic for the vast majority of procedures in neonates or small infants;however,considerable progress has been made by using techniques that decrease the need for homologous blood products or even allow bloodless surgery in older infants and children.These techniques involve a decrease in prime volume by downsizing the bypass circuit with the help of vacuumassisted venous drainage,microplegia,autologous blood predonation with or without infusion of recombinant(erythropoietin),cell salvaging,ultrafiltration and retrograde autologous priming.The three major techniques which are simple,safe,efficient,and cost-effective are:a prime volume as small as possible,cardioplegia with negligible hydric balance and circuit residual blood salvaged without any alteration.Furthermore,these three techniques can be used for all the patients,including emergencies and small babies.In every pediatric surgical unit,a strategy to decrease or avoid blood bank transfusion must be implemented.A strategy to minimize transfusion requirement requires a combined effort involving the entire surgical team with pre-,peri-,and postoperative planning and management.展开更多
文摘目的总结全胸腔镜心脏瓣膜手术体外循环(extracorporeal circulation,ECC)管理经验。方法自2016年4月至2016年9月在广东省人民医院行全胸腔镜心脏瓣膜手术119例,全部经颈内静脉和股动、静脉置管行ECC,应用负压辅助静脉引流(VAVD)技术。ECC中鼻咽温28℃~31℃,灌注流量60~80 m L/(kg.min),经加长型灌注针向主动脉根部灌注冷4∶1含血心肌保护液保护心肌。结果 119例患者ECC时间为(143.4±33.9)min,升主动脉阻断时间为(92.4±21.3)min,所有患者手术过程顺利。结论在全胸腔镜心脏瓣膜手术中辅用负压辅助静脉引流技术能明显改善单靠重力静脉引流的不足,选择相对偏大的股动脉插管管径有利术中管理,注意主动脉阻断前的温度管理。
文摘There is increasing concern about the safety of homologous blood transfusion during cardiac surgery,and a restrictive transfusion practice is associated with improved outcome.Transfusion-free pediatric cardiac surgery is unrealistic for the vast majority of procedures in neonates or small infants;however,considerable progress has been made by using techniques that decrease the need for homologous blood products or even allow bloodless surgery in older infants and children.These techniques involve a decrease in prime volume by downsizing the bypass circuit with the help of vacuumassisted venous drainage,microplegia,autologous blood predonation with or without infusion of recombinant(erythropoietin),cell salvaging,ultrafiltration and retrograde autologous priming.The three major techniques which are simple,safe,efficient,and cost-effective are:a prime volume as small as possible,cardioplegia with negligible hydric balance and circuit residual blood salvaged without any alteration.Furthermore,these three techniques can be used for all the patients,including emergencies and small babies.In every pediatric surgical unit,a strategy to decrease or avoid blood bank transfusion must be implemented.A strategy to minimize transfusion requirement requires a combined effort involving the entire surgical team with pre-,peri-,and postoperative planning and management.
