中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

体外循环中人工胶体预充不影响体重低于 5 kg 先天性心脏病患儿术后凝血功能

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目的 探索在先天性心脏病(先心病,CHD)手术体外循环(CPB)中,用人工胶体替代人血白蛋白(HSA)作为胶体预充液对体重低于 5 kg 的先心病患儿凝血功能的影响。 方法 研究纳入 2016 年 9 月至 2017 年 12 月在我院行先心病手术体重低于 5 kg 患儿 65 例,随机分为两组:人工胶体预充组(试验组,n=33)和人血白蛋白复合人工胶体预充组(对照组,n=32)。监测患儿围术期血红蛋白浓度(Hb)、血制品和止血药物使用量、术后凝血功能指标、术后 24 h 胸腔积液量等。 结果 两组患儿围术期 Hb 和 24 h 胸腔积液量差异无统计学意义。试验组关胸期间血小板使用率显著低于对照组(P<0.05)。两组患儿围术期其他血制品和止血药物使用量差异无统计学意义,术前及术后 24 h 凝血指标差异也无统计学意义(P>0.05)。 结论 在体重低于 5 kg 先心病患儿矫治术中,用人工胶体完全替代人血白蛋白作为体外循环胶体预充液未对患儿围术期凝血功能产生不良影响。

Objective To investigate the effect of artificial colloid on coagulation function in pediatric patients weighing less than 5 kg with congenital heart disease (CHD) during cardiopulmonary bypass (CPB) in congenital heart disease surgery by using artificial colloid instead of human serum albumin. Method A total of 65 pediatric with weight less than 5 kg underwent congenital heart disease surgery in our hospital from September 2016 to December 2017 were included in the study. They were randomly divided into two groups: an artificial colloid group (experimental group, n=33) and a human serum albumin combined artificial colloid group (control group, n=32). Perioperative hemoglobin concentration (Hb), blood products and hemostatic drugs used. Postoperative coagulation function index and pleural fluid volume 24 hours after surgery were monitored. Results There was no significant difference in perioperative Hb and chest tube drainage between the two groups. The platelet utilization rate in the experimental group was significantly lower than that in the control group (P<0.05). No significant difference was found in the dosage of other blood products and hemostatic drugs between the two groups during the perioperative period. There was no significant difference in coagulation parameters between the two groups before and after surgery (P>0.05). Conclusion The use of artificial colloid as colloid priming solution during cardiopulmonary bypass has no adverse effect on coagulation function in pediatric patients weighting less than 5 kg with congenital heart disease.

关键词: 体外循环; 婴幼儿; 人工胶体; 凝血功能

Key words: Cardiopulmonary bypass; children; gelatin; coagulation function

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