CAJ | 학술논문

目的：探讨逆行自体血预充技术（RAP）在心肺转流（CPB）先心病手术中的血液保护效果。方法20例先心病手术患者，随机分为对照组（n＝10）和 RAP 组（n＝10）。对照组采用常规的预充方法，RAP 组采用逆行自体血预充技术。记录 CPB 前、CPB 15 min、停 CPB 后1 h、术后24 h的 Hb、Hct 和血乳酸（Lac），并记录预充液量、术中用血量、呼吸机辅助时间、ICU 停留时间等。结果两组患者均成功进行 CPB 心脏手术，无患者死亡，无输血相关并发症。RAP 组预充液量明显少于对照组（P＜0.01）。CPB 15 min 和停 CPB 后1 h RAP 组 Hb 和 Hct 均明显高于对照组（P ＜0.05）；停 CPB 后1 h 和术后24 h RAP 组 Lac 明显低于对照组（P＜0.05）。RAP 组围术期用血量明显少于对照组（P＜0.05）。结论在 CPB 先心病手术中使用 RAP 技术可以有效的减少预充液量，减低 CPB 过程中的血液稀释，改善组织灌注，减低呼吸机辅助时间，减少术中用血量。
목적：탐토역행자체혈예충기술（RAP）재심폐전류（CPB）선심병수술중적혈액보호효과。방법20례선심병수술환자，수궤분위대조조（n＝10）화 RAP 조（n＝10）。대조조채용상규적예충방법，RAP 조채용역행자체혈예충기술。기록 CPB 전、CPB 15 min、정 CPB 후1 h、술후24 h적 Hb、Hct 화혈유산（Lac），병기록예충액량、술중용혈량、호흡궤보조시간、ICU 정류시간등。결과량조환자균성공진행 CPB 심장수술，무환자사망，무수혈상관병발증。RAP 조예충액량명현소우대조조（P＜0.01）。CPB 15 min 화정 CPB 후1 h RAP 조 Hb 화 Hct 균명현고우대조조（P ＜0.05）；정 CPB 후1 h 화술후24 h RAP 조 Lac 명현저우대조조（P＜0.05）。RAP 조위술기용혈량명현소우대조조（P＜0.05）。결론재 CPB 선심병수술중사용 RAP 기술가이유효적감소예충액량，감저 CPB 과정중적혈액희석，개선조직관주，감저호흡궤보조시간，감소술중용혈량。
Objective To investigate the clinical application of retrograde autologous priming (RAP)in congenital heart disease surgery by cardiopulmonary bypass.Methods Twenty congenital heart disease patients undergoing heart operation by cardiopulmonary bypass were randomly divided into two groups,group control (n=10)and group RAP (n=10).Group control was received the regular priming method,whereas group RAP with RAP technique.The hematologic parameters were measured before CPB,15 minutes following CPB,1 h and 24 h after CPB.The priming volume, transfusion requirements,ventilator time and ICU stay time were recorded.Results All patients were healed completely without death and transfusing complications.The priming volume in group RAP was significantly lower than that in group control (P<0.01).The levels of hemoglobin and hemato-crit in group RAP at 15 min following CPB and 1 h after CPB were significantly higher compared to group control (P<0.05).Lactate in group RAP at 1 h and 24 h after CPB were significantly lower than those in group control (P<0.05).The transfusion requirements in group RAP were significantly decreased than group control (P<0.05).Conclusion In congenital heart disease surgery by cardiop-ulmonary bypass,RAP technique can effectively decrease priming volume,hemodilution and transfu-sion requirements,improve tissue perfusion and pulmonary function.