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目的 探讨小儿体外循环心脏手术血液稀释的方法及血液稀释的安全性。方法 总结分析 35 0例小儿体外循环心脏手术过程中血液稀释度及对体外循环转流中组织的灌注效果。结果 35 0例患儿中血液稀释后最低红细胞压积 (HCT) 8%～ 10 % 31例 (A组 ) ,HCT 11%～ 15 % 2 2 7例 (B组 ) ,HCT 16 %～ 2 0 % 70例(C组 ) ,HCT 2 1%～ 30 % 2 7例 (D组 ) ,HCT 31%～ 35 % 4例 (E组 ) ,5组患儿开放升主动脉时心肌自动复跳 ,但无明显差异 (P >0 .0 5 ) ,但A组患儿应用正性肌力药物的例数和体外循环辅助时间明显高于其他四组患儿(P <0 .0 5 ) ,其它四组患儿间无明显差别 (P >0 .0 5 )。结论 休外循纠的血液稀释程度对体外循环心脏手术的心脏自动复跳率无明显的影响 ,但影响体外循环的辅助时间和正性肌力药物的用量 ;对于早期可以维持较低的红细胞压积 ,在开放升主动脉时 ,应尽量使红细胞压积达到 2 0 %以上 ,以减少体外循环辅助时间和减少术中应用正性肌力药物。
Objective To explore the method of hemodilution and the safety of hemodilution during cardiopulmonary bypass. Methods 357 cases of pediatric cardiopulmonary bypass during cardiac surgery during hemodilution and perfusion of the circulation in the cardiopulmonary bypass. Results Thirty-one patients (group A) with HCT (8% -10%), HCT 11% -15% 227 (group B) and HCT 16% -2 0 (C group), HCT2 1% ~ 30% 27 cases (D group) and HCT 31% ~ 35% (E group). In the 5 groups, the myocardium rebounded automatically when the ascending aorta was opened, But there was no significant difference (P> 0.05). However, the number of cases of inosotics and the time of cardiopulmonary bypass in group A were significantly higher than those in the other four groups (P <0.05). Other There was no significant difference between the four groups (P> 0.05). Conclusion The degree of hemodilution of Xifu Xunxian has no obvious effect on the rate of spontaneous rebound of heart during cardiopulmonary bypass, but it also affects the auxiliary time of cardiopulmonary bypass and the amount of inotrope; for early maintenance of lower hematocrit , In the open ascending aorta, hematocrit should be as much as possible to achieve 20% or more, in order to reduce the time of extracorporeal circulation and reduce the application of inotropic drugs.