中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2014年
11期
816-821
,共6页
赵明霞%苗晓蕾%冯正义%赵举%胡金晓%崔勇丽%林茹%舒强%刘晋萍
趙明霞%苗曉蕾%馮正義%趙舉%鬍金曉%崔勇麗%林茹%舒彊%劉晉萍
조명하%묘효뢰%풍정의%조거%호금효%최용려%림여%서강%류진평
体外循环%心脏病,先天性%血液凝固%凝血弹性描记术
體外循環%心髒病,先天性%血液凝固%凝血彈性描記術
체외순배%심장병,선천성%혈액응고%응혈탄성묘기술
Extracorporeal circulation%Heart disease,congenital%Blood coagulation%Thromboelastography
目的 探讨在紫绀型先天性心脏病患儿预充液中,应用4%琥珀酰明胶替代新鲜冰冻血浆的效果与安全性.方法 将80例紫绀型先天性心脏病患儿采用随机数字表法分为两组(血浆组、明胶组),每组各40例.分别应用新鲜冰冻血浆或4%琥珀酰明胶进行预充,分时点检测血常规、凝血功能、肝功能、肾功能,记录体外循环时间、阻断时间、术后出血量、血液制品输注量及恢复时间.分析一般资料及血液学参数与术后出血量的关系.结果 鱼精蛋白中和后15 min,预充新鲜冰冻血浆组患儿血浆纤维蛋白原水平[(1 672±390) mg/L]显著高于预充琥珀酰明胶组患儿[(1 355±338)mg/L],P=0.012.两组患儿在术后出血量(21.5±8.8比22.9±8.5,P=0.371)、血液制品输注量(血小板1.0u比1.0u,P=0.253;红细胞1.0u比1.5u,P=0.483;新鲜冰冻血浆(33.9±10.9)ml/kg比(35.4±11.8)ml/kg,P=0.268、肝功能[谷丙转氨酶(20.4±8.5)IU/L比(20.3±8.2)IU/L,P=0.815;谷草转氨酶[(27.7±6.1)IU/L比(28.5±6.5)IU/L,P=0.633]、肾功能[肌酐(43.8±13.1)μmol/L比(43.6±12.9)μmol/L,P=0.856;尿素氮(5.7±2.3)mmol/L比(5.3±2.2)mmol/L,P=0.632]和恢复时间(呼吸机时间39.3 h比37.5h,P=0.256;重症监护时间61.0h比60.5h,P=0.264;住院时间14d比14d,P=0.430)方面差异均没有统计学意义(P>0.05).体外循环后快速血栓弹力图(rTEG)分析中最大幅度(MA)值与术后早期的出血量呈中度相关性(r=-0.624,P<0.001).结论 应用4%琥珀酰明胶替代新鲜冰冻血浆对紫绀型先天性心脏病患儿进行预充是安全有效的.
目的 探討在紫紺型先天性心髒病患兒預充液中,應用4%琥珀酰明膠替代新鮮冰凍血漿的效果與安全性.方法 將80例紫紺型先天性心髒病患兒採用隨機數字錶法分為兩組(血漿組、明膠組),每組各40例.分彆應用新鮮冰凍血漿或4%琥珀酰明膠進行預充,分時點檢測血常規、凝血功能、肝功能、腎功能,記錄體外循環時間、阻斷時間、術後齣血量、血液製品輸註量及恢複時間.分析一般資料及血液學參數與術後齣血量的關繫.結果 魚精蛋白中和後15 min,預充新鮮冰凍血漿組患兒血漿纖維蛋白原水平[(1 672±390) mg/L]顯著高于預充琥珀酰明膠組患兒[(1 355±338)mg/L],P=0.012.兩組患兒在術後齣血量(21.5±8.8比22.9±8.5,P=0.371)、血液製品輸註量(血小闆1.0u比1.0u,P=0.253;紅細胞1.0u比1.5u,P=0.483;新鮮冰凍血漿(33.9±10.9)ml/kg比(35.4±11.8)ml/kg,P=0.268、肝功能[穀丙轉氨酶(20.4±8.5)IU/L比(20.3±8.2)IU/L,P=0.815;穀草轉氨酶[(27.7±6.1)IU/L比(28.5±6.5)IU/L,P=0.633]、腎功能[肌酐(43.8±13.1)μmol/L比(43.6±12.9)μmol/L,P=0.856;尿素氮(5.7±2.3)mmol/L比(5.3±2.2)mmol/L,P=0.632]和恢複時間(呼吸機時間39.3 h比37.5h,P=0.256;重癥鑑護時間61.0h比60.5h,P=0.264;住院時間14d比14d,P=0.430)方麵差異均沒有統計學意義(P>0.05).體外循環後快速血栓彈力圖(rTEG)分析中最大幅度(MA)值與術後早期的齣血量呈中度相關性(r=-0.624,P<0.001).結論 應用4%琥珀酰明膠替代新鮮冰凍血漿對紫紺型先天性心髒病患兒進行預充是安全有效的.
목적 탐토재자감형선천성심장병환인예충액중,응용4%호박선명효체대신선빙동혈장적효과여안전성.방법 장80례자감형선천성심장병환인채용수궤수자표법분위량조(혈장조、명효조),매조각40례.분별응용신선빙동혈장혹4%호박선명효진행예충,분시점검측혈상규、응혈공능、간공능、신공능,기록체외순배시간、조단시간、술후출혈량、혈액제품수주량급회복시간.분석일반자료급혈액학삼수여술후출혈량적관계.결과 어정단백중화후15 min,예충신선빙동혈장조환인혈장섬유단백원수평[(1 672±390) mg/L]현저고우예충호박선명효조환인[(1 355±338)mg/L],P=0.012.량조환인재술후출혈량(21.5±8.8비22.9±8.5,P=0.371)、혈액제품수주량(혈소판1.0u비1.0u,P=0.253;홍세포1.0u비1.5u,P=0.483;신선빙동혈장(33.9±10.9)ml/kg비(35.4±11.8)ml/kg,P=0.268、간공능[곡병전안매(20.4±8.5)IU/L비(20.3±8.2)IU/L,P=0.815;곡초전안매[(27.7±6.1)IU/L비(28.5±6.5)IU/L,P=0.633]、신공능[기항(43.8±13.1)μmol/L비(43.6±12.9)μmol/L,P=0.856;뇨소담(5.7±2.3)mmol/L비(5.3±2.2)mmol/L,P=0.632]화회복시간(호흡궤시간39.3 h비37.5h,P=0.256;중증감호시간61.0h비60.5h,P=0.264;주원시간14d비14d,P=0.430)방면차이균몰유통계학의의(P>0.05).체외순배후쾌속혈전탄력도(rTEG)분석중최대폭도(MA)치여술후조기적출혈량정중도상관성(r=-0.624,P<0.001).결론 응용4%호박선명효체대신선빙동혈장대자감형선천성심장병환인진행예충시안전유효적.
Objective To explore the efficiency and safety of 4% succinylated gelatin as priming solution instead of fresh frozen plasma during cardiopulmonary bypass for cyanotic heart diseases in children.Methods A total of eighty cyanotic infant patients undergoing heart surgery with extracorporeal circulation (ECC) were randomly divided into two groups (n =40 each group).Either 4% succinylated gelatin (gelatin group) or fresh frozen plasma (plasma group) was primed for ECC respectively.Rapid-thromboelastography (r-TEG) was performed after anesthesia induction and protamine administration.The postoperative parameters of renohepatic function,bleeding volume,blood product dosage and clinical recovery time were recorded.And the association between characteristics,hemostatic variables and postoperative blood loss volume were also analyzed.Results No patient developed obvious renal or liver dysfunction.Compared with gelatin group (1 355 ± 338 mg/L),plasma group showed a significantly elevated level of fibrinogen (1 672 ± 390 mg/L) (P =0.012).However,there was no clinical efficiency of adding plasma in ECC circuit since bleeding volume(21.5 ± 8.8 vs 22.9 ± 8.5,P =0.371),blood product dosage(PLT 1.0 u vs 1.0 u P =0.253;RBC 1.0 u vs 1.5 u,P =0.483 ; FFP 33.9 ± 10.9 ml/kg vs 35.4 ± 11.8 ml/kg,P =0.268) and clinical recovery time(ventilation time 39.3 h vs 37.5 h,P =0.256; ICU stay 61.0 vs 60.5 h,P =0.264;hospitalization time 14 vs 14 d,P =0.430) were comparable between two groups.The maximal amplitude (MA) after bypass was correlated with early blood loss volume after surgery.Conclusions Replacement of plasma with artificial colloid-like gelatinin for ECC circuit priming is both safe and effective for infants with congenital heart disease.And r-TEG may be used as a tool for evaluating hemostatic function after heart surgery in infant patients.