目的 探讨6%羟乙基淀粉130/0.4(万汶)和琥珀酰明胶(血定安)预充对于3岁以下先天性心脏病(先心病)手术患儿肝功能及凝血功能的影响. 方法 45例年龄≤3岁的非紫绀型先心病患者,按照随机数字法分为3组:羟乙基淀粉组(H组)、琥珀酰明胶组(G组)和血浆对照组(C组),每组15例.分别于术前(T0)、术后2 h(T1)、术后24 h(T2)及48 h(T3)采动脉血检测患者总胆红素(TBIL)、直接胆红素(DBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、凝血酶原时间(PT)、纤维蛋白原含量(FIB)、活化部分凝血酶时间(APTT)和凝血酶时间(TT).结果 三组患儿术后TBIL、DBIL和AST均明显升高,ALT H组和C组降低而G组升高(P<0.01),PT、TT明显延长,FIB显著升高(P<0.01);H组各项指标变化水平均低于C组(P<0.05). 结论 6%羟乙基淀粉130/0.4和琥珀酰明胶用于3岁以下先心病婴幼儿体外循环预充,对其肝功能和凝血功能存在不同程度的亚临床损害,且潜在损害6%羟乙基淀粉130/0.4小于琥珀酰明胶.%OBJECTIVE To evaluate the effects of hydroxyethyl starch 130/0.4 ( HES ) and succinyl gelatin used as priming solution for extracorporeal circulation ( ECC ) on hepatic function and coagulation function in infants with congenital heart disease less than 3 years. METHODS 45 infants with non - cyanosed congenital heart disease undergoing cardiac surgery with ECC were randomly divided into 3 groups ( n= 15 in each group ): HES group, GEL group and plasma group. Blood samples were taken from the arterial at before surgery ( T0 ), 2 hours ( T1 ), 24 hours ( T2 ) and 48 hours ( T3 ) after the end of operation for total bilirubin ( TBIL ), direct bilirubin ( DBIL ), alanine aminotransferase ( ALT ), aspartate aminotransferase ( AST ), prothrombin time ( PT ), activated partial thromboplastin time ( APTT ), fibrinogen ( FIB ) and thrombin time ( TT ) monitoring. RESULTS After operation, the serum TBIL, DBIL and AST levels were significant higher in 3 groups. Compared with that in the plasma group, the level of ALT obviously decreased, PT, TT and FIB were significant increased after operation in the HES and plasma group, and all theses changes were more significantly in HES group than that in plasma group. CONCLUSION Using HES and GEL as priming fluid for ECC had inequality degree potential clinic damage on hepatic function and coagulation function in infants. Compared with GEL, the potential clinical consequences of HES were lighter.
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