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目的评价在体外循环下心脏手术中实施改良节约用血策略后体重≤15 kg的先天性心脏病(先心病)患儿的围术期血液制品输入情况及临床预后。方法按入选标准纳入2012年8月至2013年10月实施改良节约用血策略(即无库血预充方案)进行相应外科治疗的患儿283例男154例、女129例,年龄中位数(四分位间距)为13(9,20)个月。如患儿在术中发生与低血红蛋白浓度相关的缺氧,则严格按照输血指征进行输血治疗并被纳入术中输血组;如术中无输血仅术后需进行输血治疗的患儿则纳入术后输血组;成功实施免输血手术的患儿纳入免输血组。收集三组患儿血液制品的用量以及住院期间一般资料,于体外循环(CPB)前、CPB开始后10 min、停机前以及停机改良超滤后分别监测血气,记录术后24 h胸腔引流量以及术后早期恢复的相关评价指标。结果术中输血组121例男71例、女50例,年龄10(8,12)个月;术后输血组56例男30例、女26例,年龄15(7,20)个月;免输血组106例,男53例、女53例,年龄14(9,22)个月。术中输血组患儿体重[9.0(7,10)kg vs.12.6(9,14)kg]、年龄[10(8,12)个月vs.14(9,22)个月]、身高[72(68,80)cm vs.86(78,97)cm]均明显低于免输血组(P<0.01),24h胸腔引流量多于免输血组[89(40,122)ml vs.58(30,106)ml,P<0.05]。术中输血组术前红细胞压积低于免输血组和术后输血组[32%(29%,37%)vs.39%(34%,41%)vs.36%(33%,38%),P<0.05]。术后输血组与术中输血组住院时间均长于免输血组[13(8,23)d vs.14(11,22)dvs.11(8,20)d,P<0.05]。结论在应用改良节约用血策略后仍有部分患儿需要术中输血且能实施免输血手术患儿住院时间更短,24 h胸腔引流量更少。准确把握围术期输血的影响因素将有可能进一步减少围术期血液制品的应用。
Objective To evaluate the perioperative blood product input and clinical prognosis of children with congenital heart disease (CHD) weighing less than 15 kg under cardiopulmonary bypass. Methods According to the inclusion criteria, 283 males and 154 females were enrolled in this study. Among them, there were 154 males and 129 females with the age-adjusted median age between August 2012 and October 2013 (corresponding to no blood prefilling plan) (Quartile spacing) of 13 (9,20) months. If the child with hypoxia associated with low hemoglobin concentration during surgery, blood transfusion in strict accordance with the indications for transfusions and was included in the transfusion group; such as intraoperative blood transfusions only blood transfusion need to be included in children Postoperative blood transfusion group; children with successful transfusion-free surgery were included in the transfusion-free group. Blood samples were collected from three groups of children and general information during hospitalization. Blood gas was monitored before cardiopulmonary bypass (CPB), 10 min after the start of CPB, before shutdown, and after modified ultrafiltration. The pleural drainage volume at 24 h postoperatively Postoperative early recovery related evaluation index. Results Among 121 transfusions, 71 were male and 50 were female, with a mean age of 10 (8,12) months. Among the 56 transfusions, there were 30 males and 26 females with a mean age of 15 (7,20) months. Transfusion group of 106 patients, 53 males and 53 females, aged 14 (9,22) months. The intraoperative blood transfusion group had significant differences in body weight [9.0 (7,10) kg vs 12.6 (9,14) kg], age [10 (8,12) months vs 14 (9,22) 72 (68,80) cm vs.86 (78,97) cm] were significantly lower than those in the transfusions group (P <0.01) ) ml, P <0.05]. The preoperative hematocrit was lower in the transfusion group than in the transfused group and in the transfused group [32% (29%, 37% vs.39% (34%, 41% vs.36% (33%, 38% ), P <0.05]. The hospitalization time in transfusions group and transfusion group were longer than those in transfusions group [13 (8,23) d vs.14 (11,22) dvs.11 (8,20) days, P <0.05]. Conclusion Some patients still need hospitalized blood transfusions after transcobilization and blood transfusion, and hospitalizations for transfusions without blood transfusion are shorter, and their thoracic drainage is less at 24 h. Accurately grasp the influencing factors of perioperative blood transfusion will be possible to further reduce the application of perioperative blood products.