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目的分析新的节约用血策略对低体重(≤8 kg)先天性心脏病患儿实现无血体外循环或减少围术期血液制品用量的可行性及对患儿早期预后的评价。方法自2011年8月至2012年1月共有76名低体重患儿分成两组,对照组(n=38)采用体外循环经典预充血策略,即2个单位悬浮少白红细胞(PRBC)和100 ml新鲜冰冻血浆(FFP)完成心脏畸形矫治术;实验组(n=38)低体重患儿实施体外循环无血预充技术并结合新节约用血策略,术中根据患儿血红蛋白浓度的变化再适量补充悬浮红细胞。收集两组患儿围术期的重要监测指标及血液制品(悬浮红细胞、新鲜冰冻血浆)的用量、术后24 h胸液量及患儿术后早期恢复的评价指标。结果实验组患儿平均每例输入PRBC和FFP的用量均明显少于对照组(P<0.01);实验组中有12例患儿实施无血体外循环手术,且术前血红蛋白浓度显著高于另外26例患儿(P<0.05),另外26例术中每例各加入1单位悬浮红细胞,每例患儿血浆用量为零;两组患儿24 h胸液量无显著性差异(P>0.05);两组患儿的术后机械通气时间和ICU停留时间无显著差异(P>0.05)。结论合理实施新节约用血策略可显著减少低体重先天性心脏病患儿的血液制品用量,未对患儿术后早期带来不良影响;术前红细胞比容大于0.36者,较易实现无血体外循环管理。
Objective To analyze the feasibility of new blood - saving strategy in children with low birth weight (≤8 kg) congenital heart disease without blood circulation or reduce the amount of perioperative blood products and to evaluate the prognosis of children with early stage. METHODS: A total of 76 children with low birth weight from August 2011 to January 2012 were divided into two groups. The control group (n = 38) was treated with classic extracorporeal circulation preconditioning strategy consisting of 2 units of PRBC and 100 ml fresh frozen plasma (FFP). The experimental group (n = 38) underwent extracorporeal circulation without preconditioning and combined with the new strategy of saving blood. The patients in the experimental group (n = 38) Appropriate amount of suspended red blood cells. The important indicators of perioperative monitoring, the amount of blood products (suspended erythrocytes and fresh frozen plasma), the amount of pleural effusion at 24 hours after operation and the early postoperative recovery were collected. Results The average amount of PRBC and FFP in each experimental group was significantly less than that of the control group (P <0.01). In the experimental group, 12 children underwent bloodless cardiopulmonary bypass and the preoperative hemoglobin concentration was significantly higher than the other 26 cases (P <0.05). In addition, 26 cases were added 1 unit of suspended erythrocytes in each case, the plasma dosage was zero in each case. There was no significant difference in the amount of pleural effusion at 24 hours between the two groups (P> 0.05 ). There was no significant difference in postoperative mechanical ventilation time and ICU stay between the two groups (P> 0.05). Conclusion The rational implementation of the new blood-saving strategy can significantly reduce the amount of blood products in children with low birth weight congenital heart disease, without adverse effects on the early postoperative children; preoperative hematocrit greater than 0.36, easier to achieve without blood Cardiopulmonary bypass management.