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目的探索改良节约用血策略对体重≤15 kg先天性心脏病患儿的安全性,并分析体外循环中传统与改良库血预充策略对患儿围术期血制品输注情况及近期临床预后。方法自2011年2月至2013年10月,按入选标准先后纳入531例先天性心脏病患儿。传统组(C组,n=248例)患儿采用库血预充方案,改良组(M组,n=283例)患儿实施改良节约用血策略即无库血预充方案,所有患儿行体外循环下心脏手术,收集转前及转中、转后不同时点的血气指标及围术期的资料。结果两组患儿初步分析表明,改良组患儿围术期红细胞用量明显少于传统组(P<0.001);改良组患儿术后机械通气时间、ICU停留时间及24 h胸液引流量明显低于传统组(P=0.028,P=0.034,P=0.012);两组患儿住院时间、再次气管插管、术后腹透及死亡率等均无统计学差异(P>0.05)。结论在体重≤15 kg先天性心脏病患儿体外循环期间实施改良节约用血策略是安全可行的,该策略有助于减少围术期的血制品用量,改善患儿近期预后。
Objective To explore the safety of modified blood-conserving strategy for children with congenital heart disease ≤ 15 kg body weight and to analyze the effect of traditional and modified pre-charge strategy of cardiopulmonary bypass on infantile blood transfusion and recent clinical prognosis . Methods From February 2011 to October 2013, 531 children with congenital heart disease were included according to the inclusion criteria. In the traditional group (group C, n = 248), the pre-charge program of blood bank was used. In the improved group (M group, n = 283), the modified blood-saving strategy was used, Cardiac surgery under cardiopulmonary bypass was collected before and after the transfer, transfer at different points after the blood gas index and perioperative data. Results The preliminary analysis of two groups of children showed that the dosage of perioperative erythrocytes in the modified group was significantly less than that of the traditional group (P <0.001). The mechanical ventilation time, ICU stay time and the amount of pleural effusion in the modified group were significantly (P = 0.028, P = 0.034, P = 0.012). There was no significant difference in hospitalization time, tracheal intubation, peritoneal dialysis and postoperative mortality between the two groups (P> 0.05). Conclusions It is safe and feasible to implement an improved blood-saving strategy during cardiopulmonary bypass in children with congenital heart disease ≤ 15 kg. This strategy can reduce the amount of perioperative blood products and improve the prognosis of children.