低于15公斤患儿心脏手术围体外循环期改良节约用血策略的安全性分析

摘要

目的：探索改良节约用血策略对体重≤15 kg先天性心脏病患儿的安全性，并分析体外循环中传统与改良库血预充策略对患儿围术期血制品输注情况及近期临床预后。方法自2011年2月至2013年10月，按入选标准先后纳入531例先天性心脏病患儿。传统组（ C组，n＝248例）患儿采用库血预充方案，改良组（ M组，n＝283例）患儿实施改良节约用血策略即无库血预充方案，所有患儿行体外循环下心脏手术，收集转前及转中、转后不同时点的血气指标及围术期的资料。结果两组患儿初步分析表明，改良组患儿围术期红细胞用量明显少于传统组（ P＜0．001）；改良组患儿术后机械通气时间、ICU停留时间及24 h胸液引流量明显低于传统组（ P ＝0．028， P ＝0．034， P ＝0．012）；两组患儿住院时间、再次气管插管、术后腹透及死亡率等均无统计学差异（ P＞0．05）。结论在体重≤15 kg先天性心脏病患儿体外循环期间实施改良节约用血策略是安全可行的，该策略有助于减少围术期的血制品用量，改善患儿近期预后。%Objective To evaluate the safety of modified blood-sparing approach in low-body weight infants(≤15 kg) with congenital heart disease, we analyzed the effect of blood-free priming strategy on transfusion requirements and short-term prognosis. Methods A total of 531 infants were included betweenFebruary 2011 and October 2013, according to internalize standard strictly, in⁃fants were divided into two groups:control group ( C group, n=248) for traditional priming strategy,and modified group ( M group, n=283) for a new blood-sparing approach. All infants experienced routine heart surgery with cardiopulmonary bypass. Blood samples were collected as following time points:pre-CPB,10min after CPB,before termination of CPB, after modified ultrafiltration. Clinic data and transfusion requirements were collected during operation, in ICU, and in ward. Results In the study, packed red blood cell dur⁃ing admission in M group were less than C group ( P<0.01), as well as endotracheal intubation time, ICU stay, and total 24-hour chest tube output ( P =0.028, P =0.034, P =0.012) , however there was no difference in admission time, re-intubation, peritoneal dialysis and death between two groups ( P>0.05) . Conclusion Our research elucidated that modified blood-sparing approach can re⁃duce blood transfusion during admission without poorer outcome.