婴幼儿体外循环中人工胶体液代替血浆的综合评价

摘要

Objective To discuss the effect and safety of the replacement of plasma with artificial colloids in infants over 8 Kg undergoing heart surgery with cardiopulmonary bypass (CPB).Methods 90 infant patients undergoing heart surgery with CPB were divided into 3 groups randomly.4％ succinylated gelatin (Gelofusine),6％ hydroxyethyl starch 130/0.4 (Voluven) or plasma were primed for CPB respectively and the largest usage was 20 ml/kg.Colloid osmotic pressure,hemoglobin amount,platelet count,albumin amount,total protein amount,urea nitrogen level,creatinine level,ultrafiltration volume,urine volume and chest-tube drainage volume at several points,together with supportively ventilative time and ICU stay time were recorded and statistically analyzed.Results There was no difference in hemoglobin amount,platelet count,albumin amount,total protein amount,urea nitrogen level,creatinine level,ultrafiltration volume,urine volume and chest-tube drainage volume among 3 groups (P ＜0.05).Colloid osmotic pressure was higher in priming fluid containing Gelofusine or Voluven (P ＜ 0.05),while there was no difference in plasma colloid osmotic pressure among 3 groups (P ＞0.05).Both supportively ventilative time and ICU stay time were shorter in Gelofusine group and Voluyen group than in plasma group with no significant differences.Conclusion Replacement of plasma with Gelofusine or Voluven can be used for infant patients over 8 kg.The largest usage of 20 ml/kg is safe during CPB.We should make further study on coagulation function of infant patients using Gelofusine or Voluven for priming in future.%目的 探讨8 kg以上婴幼儿体外循环中人工胶体液代替血浆的效果与安全性.方法 90例在体外循环下行先天性心脏病首次矫正手术的患儿随机分为三组,分别应用佳乐施、万汶和血浆预充.胶体总量(预充量+转中用量)最高达20ml/kg.分时点观察胶体渗透压、血红蛋白(Hb)、血小板、白蛋白、总蛋白、尿素氮(BUN)、肌酐(Cr)、超滤量、尿量、胸液量、气管插管时间及ICU停留时间,进行统计学分析.结果 佳乐施组和万汶组在Hb、血小板、白蛋白、总蛋白、肾功能(BUN、Cr)、超滤量、各时点的胸液量及尿量、乳酸方面与血浆组无差异(P＞0.05).佳乐施组、万汶组预充液的胶体渗透压高于血浆组(P＜0.05),三组患儿转前、转中、转后与术后24 h的血浆胶体渗透压无差异(P＞0.05).万汶组和佳乐施组在气管插管时间与ICU时间上稍短于血浆组,但无统计学差异.结论 8 kg以上患儿可应用万汶或佳乐施代替血浆预充,整个体外循环中胶体用量在20 ml/kg以下比较安全.