改良密闭式引流装置对心脏直视手术患者术中红细胞的影响

摘要

Objective To study the effects of improved closed drainage device on the erythrocyte destruction for patients undergoing open heart surgery .Method 70 patients underwent open heart surgery under cardiopulmonary bypass (CPB) were randomly divided into two groups :experimental group (Group A ,35 cases ,the modified closed gravity drainage and exhaust group) and control group (Group B ,35 cases ,the traditional open exhaust and vacuum suction group) .Indicators of erythrocyte destruction including free hemoglobin in blood serum (FHb) and K+15 min (T0 ) before bypass ,5~7min in aortic opening during bypass (T1 →T1 aorta ,T1exhaust or T1 storage ) and at the bypass stop (T2 ) were measured and compared between the two groups ,as well as urine volume and color . And the postoperative complication caused by air embolism was observed .Result The comparison of the indicators of erythrocyte destruction between Group A and Group B showed that at the interval T 1 ,the T1exhaust point of Group A was earlier than T1storage of Group B ,P<0 .01 .At T2 point ,Group A was also earlier than that of Group B , P<0 .05 .The incidence of hemoglobin urine in Group A was less than that of Group B ,P<0 .05 .No air embolism was found in Group A which reached the same effect as Group B nevertheless .There were no significant difference in indicators of erythrocyte destruction at other points between the two groups (P>0 .05) .Conclusion The adoption of the modified closed drainage device can reduce erythrocyte destruction caused by persistent vacuum suction ,using gravity drainage to discharge intracardiac bubbles mixed with blood .%目的：探讨采用改良密闭式引流装置对心脏直视手术患者术中红细胞破坏的影响。方法对70例体外循环（C PB ）心脏直视手术的患者，随机分为A、B两组（A组35例，用改良密闭式重力引流装置排气，B组35例，用传统开放式排气、负压吸引，比较两组患者转流前15 min（T0）、转流中主动脉开放5～7 min（T1→ T1主、T1排或T1贮）、转流停止（T2）血清中游离血红蛋白（FHb）、钾（K＋）等红细胞破坏指标值；尿量及尿色；观察术后是否并发气栓并发症。结果两组患者红细胞破坏指标比较，在 T1时段，A组（组间）T1排时点明显小于B组 T1贮时点，P＜0．01。在T 2时点，A组也小于B组，P＜0．05。A组发生血红蛋白尿少于B组，P＜0．05。两组均无气栓并发症发生。两组患者其它时点红细胞破坏指标值，差异无显著意义（P＞0．05）。结论采用改良密闭式引流装置，利用重力引流排出心腔内的混血气泡，减少了因持续负压吸引造成的红细胞破坏。