婴幼儿体外循环中预充库血两种处理的对比研究.docVIP

精品论文 参考文献 婴幼儿体外循环中预充库血两种处理的对比研究 郑振雄 阮秀璇 江国建 林剑兵 林榕 （福建医科大学省立临床学院lt;福建省立医院麻醉科gt; 福建福州 350001) 【中图分类号】R726 【文献标识码】A【文章编号】1672-5085（2013）1-0424-03 【摘要】 目的 使用国产血液回收机(Ce ll Saver)对库存浓缩红细胞进行清洗, 以观察库存浓缩红细胞清洗后预充对婴幼儿体外循环管理的影响。方法 将全组依CPB预充方案的不同随机分两组: 常规组（Ⅰ组）, 11例, 先用生理盐水将CPB 和超滤系统同时预充循环排气, 再用库存浓缩红细胞等预充成份(包括新鲜冰冻血浆、白蛋白、甘露醇、甲基强地松龙和碳酸氢钠)排出CPB系统内的生理盐水。清洗组（Ⅱ组）,12例, 使用国产血液回收机(Ce ll Saver)对库存浓缩红细胞进行清洗，再用清洗后浓缩红细胞等预充成份排出CPB系统内的生理盐水。结果 与Ⅱ组比较，Ⅰ组预充的浓缩红细胞HCT低，二氧化碳分压（PCO2）、血糖（GLU）、LAC 、血钾（K﹢）均比较高，Ⅰ组患儿在体外循环管理过程中，5%碳酸氢钠用量较多且血中乳酸高。两组患者无死亡, 均顺利出院。Ⅰ组患儿术后用药﹑呼吸机使用时间和住ICU时间与Ⅱ组比较差异无统计学意义。结论 婴幼儿体外循环预充用血尽量使用比较新鲜血液，以避免因大量输库血给婴幼儿带来不可预知损害。 【关键词】 婴幼儿 体外循环 库血 两种处理 【Abstract】Objective The use of domestic blood recycling system inventory of red cell concentrates for cleaning, to observe the inventory of concentrated red cells after cleaning priming effects of extracorporeal circulation management. Methods The whole group according to CPB precharging scheme were randomly divided into two groups of different , The conventional group (groupⅠ) , In 11 cases, Use normal saline CPB and ultrafiltration system simultaneously precharging circulation exhaust , Then the stock of red cell concentrates and precharge component (including fresh frozen plasma, albumin, mannitol, methylprednisolone and sodium bicarbonate) from CPB system within the physiological saline. Cleaning group(group Ⅱ), In 12 cases, The use of domestic blood recycling system inventory of red cell concentrates for cleaning, Then after washing red cell concentrates and precharge component from CPB system within the physiological saline . Results Compared with group Ⅱ, Group Ⅰ precharging of concentrated red blood cells with low HCT, partial pressure of carbon dioxide (PCO2), GLU, LAC, potassium (K+) is higher. Group I patients during cardiopulmonary bypass in the management process， 5% sodium bicarbonate content and more blood lactic acid is high，Two groups of patients without death，Were successfully discharged from hospita