摘要
目的评价改良超滤用于重症心脏瓣膜病患者心肺转流(CPB)后剩余机血处理对凝血功能的影响。方法择期行瓣膜置换术的重症心脏瓣膜病患者60例,随机分为直接回输组(DF组,n=30)和改良超滤组(MUF组,n=30)。DF组CPB停机后机血回收入储血袋后在需要时回输,而MUF组CPB结束后通过改良超滤浓缩机体血液并回输机血直至CPB管路剩余血全部回输体内。分别于诱导后(T1)、CPB开始(T2)、CPB结束(T3)、术后1 h(T4)、术后6 h(T5)和术后24 h(T6)监测凝血功能,T3~T6的净液体量、纤维蛋白原和凝血酶原复合物使用量、异体输血量和鱼精蛋白肝素量,术后24 h胸腔引流量,以及呼吸机支持时间、ICU停留时间和住院时间。结果MUF组T3~T4时点的血红蛋白(Hb)显著高于DF组(P<0.05);T4时点的血小板和D-二聚体显著高于DF组;T4~T5时点鱼精蛋白、纤维蛋白原和凝血酶原复合物的使用量DF组显著高于MUF组,而DF组晶体补液量低于MUF组,浓缩红细胞使用量和胸液引流量高于MUF组;在CPB结束后的改良超滤中,MUF组平均额外滤除787 ml的液体,同时剩余机血全部回输体内。此外各时间点的活化凝血时间、部分凝血活酶时间、凝血酶原时间以及胶体溶液使用量、血浆使用量、24 h胸液量、尿量和术中超滤量均无显著性差异。结论与机血直接回输相比,重症瓣膜病患者CPB后剩余机血经改良超滤回输后可有效提高患者术后短期Hb水平,减少异体血输注、胸液引流量和促凝药物的使用,但并不能改善术后总出血量和临床结果。
Objective To evaluate the effect of modified ultrafiltration on coagulation function by processing residual cardiopul⁃monary bypass(CPB)blood in patients with severe valvular heart disease after CPB.Methods Sixty patients with severe valvular dis⁃ease were randomly divided into two groups:direct retransfusion group(DF group,n=30)and modified ultrafiltration group(MUF group,n=30).In DF group,at the end of CPB,the residual blood was recycled into the blood storage bag and re-transfused back when needed,while in MUF group,the body blood was concentrated by MUF and all the CPB blood was transfused back to the body immediately after CPB.Coagulation function was monitored at six time points:after anesthesia induction(T1),at the beginning of CPB(T2),at the end of CPB(T3),1,6 and 24 hours after the operation(T4,T5 and T6).Net fluid volume,fibrinogen and prothrom⁃bin complex,allogeneic blood transfusion,heparin and protamine were monitored at T3-T6 respectively.Thoracic drainage volume at 24 hours after the operation,ventilation duration,ICU stay and hospital stay were recorded.Results The concentration of HB at T3-T4 and the concentration of platelet and D-dimer at T4 in MUF group were significantly higher than those in DF group(P<0.05);the use of protamine,fibrinogen and prothrombin complex at T4-T5 in DF group were significantly higher than those in MUF group;how⁃ever,the amount of crystal fluid supplement was lower than that in MUF group,the use of packed red blood cells and the chest drain⁃age were higher than those in MUF group;the average filtered fluid in the MUF group was 787 ml,and the CPB blood was all returned to the body.In addition,there was no significant difference in ACT,APTT,PT as well as the use of colloidal solution,plasma,24 hour chest drainage,urine and intraoperative ultrafiltration between the two groups.Conclusion Compared with direct retransfusion,the processing of residual CPB blood by MUF in patients with severe valvular disease can effectively improve the short-term Hb level,re⁃duce allogeneic blood transfusion,chest drainage and the use of coagulant,but it can not improve the total amount of chest drainage and clinical results.
作者
袁从虎
钱静
郭震
于广东
纪月珑
Yuan Conghu;Qian Jing;Guo Zhen;Yu Guangdong;Ji Yuelong(Department of Anesthesiology,the Third People's Hospital Yancheng City,Jiangsu Yancheng 224001,China)
出处
《中国体外循环杂志》
2020年第6期345-349,共5页
Chinese Journal of Extracorporeal Circulation
关键词
心脏瓣膜置换
心肺转流
改良超滤
转流剩余机血
血液保护
Heart valve replacement
Cardiopulmonary bypass
Modified ultrafiltration
Residual cardiopulmonary bypass volume
Blood conservation
