摘要
目的探讨小儿体外循环(ECC)中不同Hb浓度对血乳酸及术后转归的影响。方法将择期行先天性心脏病体外循环下心内直视手术患儿60名随机分为3组,每组各20名。组Ⅰ接受轻度血液稀释,Hb达(80—90)g/L;组Ⅱ接受中度血液稀释,Hb达(70—79)g/L;组Ⅲ接受重度血液稀释,Hb达(60—69)g/L。记录比较各组ECC前、ECC中、ECC后和术后24h乳酸含量、动脉氧分压(PaO2),各组体外循环库血使用率、术后呋塞米用量、术后并发症和恢复时间。结果3组乳酸浓度和PaO2在ECC前、ECC中、ECC后和术后24h均在正常范围,3组间均无统计学差异(P>0.05);体外循环库血使用率组Ⅱ(30%)和组Ⅲ(15%)均明显少于组Ⅰ(50%);但术后呋塞米用量组Ⅱ和组Ⅲ均明显高于组Ⅰ(P<0.05);3组患儿均痊愈出院且并发症少。结论小儿体外循环应用中度血液稀释[Hb(70—79)g/L]和重度血液稀释[Hb(60—69)g/L]对乳酸和术后转归无影响,可明显减少库血用量。
Objective To study the effects of different levels of hemodilution during extracorporeal circulation （ ECC ） on the concentration of lactic acid and postoperative outcome in children with congenital heart disease. Methods Sixty children with congenital heart diseases undergoing open heart surgery with ECC were randomly divided into three groups： group Ⅰ （ n = 20 ） underwent mild hemodilution [ Hb （ 80-90 ） g/L] , group Ⅱ （ n = 20 ） with medium hemodilution [ Hb （70-79） g/L], and group Ⅲ（ n = 20 ） with deep hemodilution [ Hb （ 60-69 ） g/L]. The concentration of lactic acid and PaO2 in group Ⅱ and group Ⅲ were compared with group Ⅰ before ECC, during ECC, after ECC and 24h after the operation. The rate of homologous transfusion during ECC and the postoperative dosage of furosemide were also compared among the three groups. Results The concentrations of lactic acid and PaO2 in the three groups were all within normal range before ECC, during ECC, after ECC and 24h after operation. The homologous transfusion rate during ECC were lower in group Ⅱ （ 30% ） and group Ⅲ （ 15% ） compared to that of group Ⅰ （ 50% ） （ P 〈 0.05 ） , but the dosage of furosemide in group Ⅱ and group Ⅲ was higher than that in group Ⅰ （ P 〈 0.05 ）. Children in all three groups recovered well and had few complications. Conclusion ECC with medium or deep hemodilution [ Hb （ 60-79 ） g/L ] had no adverse effects on lactic acid and postoperative outcome. It may reduce the requirements of homologous transfusion.
出处
《中国输血杂志》
CAS
CSCD
2008年第7期490-492,共3页
Chinese Journal of Blood Transfusion
关键词
小儿
体外循环
血红蛋白
乳酸
术后转归
血液稀释
Children
Extracorporeal circulation
Hemoglobin
Lactic acid
Postoperative outcome
