缩短体外循环管道对新生儿和小婴儿心脏手术输血量的影响

目的回顾分析了逐步缩短体外循环管道对新生儿和小婴儿心脏手术输血量的影响。方法将2000年至2010年体重10kg以下病人4822例,分为3组：组1（n=1265）Dedico901/902/Medtronic氧合器＋Stockert II/Jostra HL20人工心肺机;组2（n=2534）Rx-05氧合器＋Stockert II/Jostra HL20人工心肺机;组3（n=1023）Rx-05氧合器＋Jostra HL30人工心肺机。比较各组预充总量,红细胞悬液的使用量和血球压积。结果组3和组2的预充量显著低于组1预充量（组1,718±15ml;组2,458±15ml;组3,334±8ml,P〈0.001）。围术期各组血球压积无显著差异;然而各组在预充液中加入的红细胞悬液有显著差异（组1,313±5 ml;组2,205±5ml;组3,167±8ml,P〈0.001）,体外循环转流中加入的红细胞悬液组间也有显著性差异（组1,117±8ml;组2,88±7ml;组3,60±8ml,P〈0.001）。结论通过改进氧合器和缩短管道长度能减少预充量和总用血量,逐步向不用血心脏外科迈进。

Effects of Miniaturization of Cardiopulmonary Bypass Circuits on Blood Transfusion Requirement in Neonatal and Infant Open Heart Surgery

Objectives We conducted a retrospective analysis of the effect of stepwise miniaturization of the cardiopulmonary bypass（CPB） circuit on homologous blood requirement during neonatal and infant open heart surgery.Methods All patients（n=4822） weighing less than 10Kg undergoing open heart surgery between 2000 and 2010 were divided into three groups： group 1（n=1265）,Dedico 901/902 /Medtronic oxygenator＋Stockert II/Jostra HL20 heart-lung machine;group 2（n=2534）,Rx-05 oxygenator＋Stockert II/Jostra HL20 heart-lung machine;group 3（n=1023）,Rx-05 oxygenator＋ Jostra HL30 heart-lung machine.Amount of priming volume,red blood cell use and hematocrit were compared.Results Priming volume in group 3 and 2 was significantly less compared with group 1（group 1,718±15ml;group 2,458±15ml;group 3,334±8ml,P0.001）.The hematocrit values during the perioperative did not differ among the groups;however there was a significant difference in the amount of RBC used in the priming（group 1,313±5 ml;group 2,205±5ml;group 3,167±8ml,P0.001）,as well as during CPB（group 1,117±8ml;group 2,88±7ml;group 3,60±8ml,P0.001）. Conculsion By downsizing the oxygenator and reducing the circuit tubing length,we succeed to reduce the priming volume and subsequently the total use of blood and it is a proper step towards transfusion-free cardiac surgery.