作　　者： ; ; ;

机构地区： 深圳市儿童医院

出　　处： 《中国体外循环杂志》 2020年第1期12-16,共5页

摘　　要： 目的探讨婴幼儿心脏直视手术中微小化体外循环(ECC)策略下选择性使用超滤的可行性和有效性。方法回顾性分析2015年5月至2019年7月行ECC下心脏直视手术的体重≤15 kg婴幼儿共1 816例,分为传统ECC(n=644)和微小化ECC(n=1 172)。两组并进行一般情况比较,对术后结局按是否使用超滤分为传统超滤组(n=492)和微小化不超滤组(n=1 009)进行比较;再根据患儿体重进行分层(体重≤4 kg,4 kg<体重≤8 kg,8 kg<体重≤15 kg),比较不同ECC策略下两组预充量、尿量、无血预充率、超快通道率、血细胞比容(HCT)、乳酸(Lac)、术后机械通气时间及ICU滞留时间等指标。结果微小化ECC患儿的预充量明显低于传统组。不同体重下超滤组的尿量和无血预充率明显低于不超滤组(P <0.05)。体重≤4kg的患儿中超滤组术后Lac略高于不超滤组(P <0.05),4 kg<体重≤8 kg的患儿中超滤组术后HCT略高于不超滤组(P <0.05),其余血气指标差异均无统计学意义(P>0.05)。仅8 kg<体重≤15 kg的患儿中微小化不超滤组的超快通道率略高于超滤组(P <0.05),其余体重患儿中两组差异无统计学意义(P>0.05);仅体重≤4 kg的患儿中两组的术后ICU滞留时长的差异无统计学意义,其余体重患儿中微小化不超滤组的术后机械通气时长和术后ICU滞留时长均明显低于超滤组(P <0.05)。结论使用微小化ECC管路和选择性使用超滤的策略可以减少临床用血、不延长术后机械通气时间和术后ICU滞留时间。 Objective To explore the feasibility and effectiveness of selective use of ultrafiltration in infants and young children undergoing open heart surgery with mini-exeracorporeal circulation( ECC). Methods We retrospectively analyzed the data of 1816 pediatric patients( weight≤15 kg) who underwent open heart surgery from March 2015 to July 2019. Patients were divided into ultrafiltration group with conventional ECC( n = 492) and non-ultrafiltration group with mini-ECC( n = 1009). Priming volume,bloodless priming rate,ultra-fast track rate,hematocrit,lactic acid levels,mechanical ventilation time and length of stay in the ICU after surgery were collected. Results Priming volume in mini-ECC group was significantly lower than that in conventional ECC group. The urine volume and bloodless priming rate of the ultrafiltration group with different body weight were significantly lower than those of the non-ultrafiltration group( P <0.05). Only in children whose weight was >4 kg and ≤8 kg,the ultra-fast track rate of the ultrafiltration group was lower;there was no significant difference in the mechanical ventilation time and the length of stay in the ICU between the two groups with children’s weight≤4 kg( P >0.05). The mechanical ventilation time and the length of stay in the ICU were significantly lower in the non-ultrafiltration group than those in the ultrafiltration group among other children( P <0.05). Conclusion The selective use of ultrafiltration based on mini-ECC can reduce the use of blood,but without prolonging mechanical ventilation time and length of stay in the ICU.

关 键 词： 微小化体外循环 超滤 婴幼儿 心脏直视手术 无血预充

领　　域： []