摘要
目的 探讨法洛四联症心内直视手术中的血液保护方法.方法 分析2010年1月至2014年5月我院75例法洛四联症根治术患者资料.按我院开始行血液保护措施时间将患者分为2组,对照组（31例）和血液保护组（44例）,两组患者采用常规预充方法.血液保护组预计体外循环（ECC）转流中红细胞压积（HCT）＞30％时,经腔静脉插管放血,转流中维持HCT 25％,停机后给予改良超滤提高HCT至30％,并保持体温35℃～36℃;对照组HCT＞30％不予处理,停机后HCT＜30％给予输注红细胞悬液.比较两组患者体外循环预充用血量和预充用血浆量、血红蛋白（Hb）、胶体渗透压（COP）、乳酸值（Lac）、尿液颜色等.结果 所有患者均痊愈出院,无严重脏器损害.预充用血量对照组明显高于血液保护组（180.0 ml比121.4 ml,P＜0.05）,但预充用血浆量两组患者比较未见统计学差异（P＞0.05）.转中Hb、COP及转后Hb两组患者比较未见统计学差异（115.5 ml比121.5 ml,P＞0.05）,转后血液保护组COP高于对照组（P＜0.05）,但转后血液保护组Lac明显低于对照组（P＜0.05）,对照组出现血红蛋白尿比例高于血液保护组（P＜0.05）.结论 法洛四联症手术中综合应用血液保护措施安全可行,能有效减少围术期用血量,有利于患者恢复.
Objective To explore the method of blood conservation for tetralogy of Fallot during the op- eration. Methods 75 eases of tetralogy of Fallot accepted radical operation were divided into two groups： control group（n=31 ） and blood conservation group（n=44）, according the beginning time of blood conservation from Jan- uary 2010 to March 2014 in our hospital, both of the two groups received the regular priming method. Group blood conservation： blood was draining from the vena cava intubation when HCT〉30% and maintained hematocrit（HCT） 25% during extraeorporeal circulation （ECC）, modified ultrafiltration was used to improve HCT to 30% and keep the temperature 35 ℃-36 ℃ after ECC. Group controlled： no treatment when HCT greater than 30% during ECC, red cell suspension was transfused if HCT〈30% after ECC. The priming volume of blood and plasma, hemoglobin （Hb）, colloid osmotic pressure （COP）, lactate （Lac） and urine of the Extracorporeal Circulation （ECC） were compared. Results All cases recovered smoothly, and without severe organs damage. Priming volume of blood in the control group was significantly higher than that in blood conservation group （180.0 ml vs 121.4 ml, P〈0.05）, but priming volume of plasma was no significant difference between the two groups （115.5 ml vs 121.5 ml, P〉0.05）. There were no differences among the two groups in Hb, COP during ECC （P〉0.05）. The COP was higher in blood conservation group, but the Lac was lower than that in control group after ECC （P〈0.05）. Frequency of Hemoglobin- uria in the control group was higher than in the blood conservation group（P〈0.05 ）. Conclusion It is safe and feasi- ble for tetralogy of Fallot operation when the comprehensive blood conservation strategy is used, and can effectively reduce the perioperative transfusion, which is benefit for the patient＇s recover.
出处
《中国心血管病研究》
CAS
2015年第6期552-555,共4页
Chinese Journal of Cardiovascular Research
关键词
法洛四联症
心脏手术
血液保护
Tetralogy of Fallot
Cardiac surgery
Blood conservation
