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目的探讨应用综合策略实施婴幼儿无血心脏直视手术的可行性并对实施无血心脏直视手术的患儿围手术期安全性进行评价。方法自2013年12月至2015年12月共选择6~15kg先天性心脏病(先心病)患儿320名,随机分为2组,对照组(n=160)采用传统体外循环及手术方式,实验组(n=160)实施无血心脏直视手术策略,即使用微型体外循环管路和人工膜肺降低预充量,使用负压辅助静脉引流和改良超滤技术保证术中术后的血红蛋白水平,应用血液回收减少术中血液丢失等综合策略实现无血心脏手术。结果实验组患儿127例成功实施了全程无血心脏直视手术,另外5例于术中加入红细胞,28例于术后在监护室输入红细胞,均无严重并发症发生;33例未成功实施无血心脏直视手术的患儿体重、术前血红蛋白水平、术后24小时引流量与127例成功实施无血手术的患儿有显著差异(P<0.05)。结论 6~15kg的先心病患儿实施无血心脏手术是安全的,且可以节约用血,围手术期恢复更好。影响成功实施婴幼儿无血心脏直视手术的三大重要因素为:患儿体重、术前血红蛋白水平、术后引流量。
Objective To explore the feasibility of using integrated strategies to implement open heart surgery in infants and toddlers and to evaluate the perioperative safety of children undergoing open heart surgery with open heart surgery. METHODS: From December 2013 to December 2015, 320 children with congenital heart disease (CHD) of 6 ~ 15 kg were randomly divided into 2 groups. The control group (n = 160) was treated with conventional cardiopulmonary bypass and operation method. In the experimental group (n = 160), the strategy of open heart surgery with bloodless cardioplegia was demonstrated by using mini-percutaneous loop and artificial lung to reduce the pre-charge, using negative pressure assisted venous drainage and modified ultrafiltration to ensure postoperative hemoglobin Level, the application of blood recovery to reduce intraoperative blood loss and other comprehensive strategy to achieve blood-free cardiac surgery. Results In the experimental group, 127 cases were successfully treated with open heart surgery without blood and the other 5 cases were treated with erythrocyte during operation. Erythrocytes were infiltrated into the intensive care unit after operation in 28 cases. No serious complication occurred in 33 cases. There was a significant difference (P <0.05) in weight, preoperative hemoglobin level, and the amount of drainage at 24 hours after operation without blood heart surgery in 127 children with successful bloodless surgery. Conclusion Children with CHD of 6 ~ 15kg are safe without blood-cardio-cardiac surgery, and blood can be saved. Perioperative recovery is better. Impact on the successful implementation of infants and children without blood heart open surgery three important factors are: weight of children, preoperative hemoglobin levels, postoperative drainage.