纯晶体溶液与晶胶混合溶液作为体外循环预充液在成人单纯心脏瓣膜置换术体外循环中应用的比较研究

摘要

Objective To investigate physiological changes in peri extracorporeal circulation period of patients who underwent cardiac valve replacement surgeries with crystalloid solution mixed with colloidal solutions and pure crystal solution as extracorporeal circulation priming solution, and explore the clinical value and practicability of crystalloid solution as the sole extracorporeal circulation priming solution.Methods A retrospective analysis was performed in 130 patients who underwent cardiac valve replacement surgeries.Pure lactated Ringer's solution liquid and Lactated Ringer's solution mixed with Voluven as the extracorporeal circulation priming solution were used.We respectively compared hematocrit at different time points, postoperative blood routine, liver and kidney function, blood coagulation index, duration of intensive care and trachea cannula in two groups.Results There were no significant differences in ages, preoperative blood routine, kidney function, blood coagulation function, duration of operation, clamping time, bypass time, intensive care, postoperative blood routine, kidney function, blood coagulation function and hematocrit at different time points in two groups (P ＞0.05).However, the hospital day of group which used crystalloid solution as extracorporeal circulation priming solution was significant shorter compared to group which used lactated Ringer's solution mixed with Voluven (P ＜ 0.05).Alanine aminotransferase of group which used crystalloid solution as extracorporeal circulation priming solution was significant higher compared to group which used lactated Ringer's solution mixed with Voluven (P ＜0.01).Conclusions Crystalloid solution as extracorporeal circulation priming solution is safe and economy in cardiopulmonary bypass.Pure crystalloid solution as the sole extracorporeal circulation priming solution can be safely used on patients (New York Heart Association class Ⅱ-Ⅲ) who have normal liver and kidney function before the operation of adult heart valve replacement with cardiopulmonary bypass.%目的 比较单纯使用晶体溶液和晶胶混合溶液作为体外循环预充液对心脏瓣膜置换术患者围体外循环期几项生理变化相关指标的影响,探讨单纯使用晶体溶液作为体外循环预充液的临床价值和可行性.方法 回顾性分析2013年130例体外循环下行心脏瓣膜置换术患者的临床资料,比较单纯使用晶体(乳酸林格液)与晶胶混合溶液(乳酸林格液和万汶)作为体外循环预充液的两组患者,在麻醉诱导后,体外循环开始后20 min,停机后,手术结束后及术后18h监测红细胞比容,以及术后血常规、肝肾功能、凝血功能、监护室停留时间、气管插管时间等.结果 晶体组与晶胶组的气管插管时间、监护室停留时间、术后血常规、肾功能、凝血功能及各个时间点的红细胞比容结果比较差异无统计学意义(P＞0.05).但晶体组的住院时间明显短于晶胶组(P＜0.05),同时晶体组谷丙转氨酶高于晶胶组,差异均有统计学意义(P＜0.01).结论 纯晶体溶液可以作为体外循环预充液安全用于术前心功能2～3级(NYHA)、肝肾功能基本正常的成人心脏瓣膜置换术,是一种既经济又安全的体外循环预充液.