摘要：
目的 探讨体外循环期间采用人工胶体万汶预充策略对婴幼儿术后凝血功能及临床转归的影响,评价其能否安全用于婴幼儿,为临床节约血浆提供依据.方法 选择2017年2～5月择期行先天性心脏病矫治术患儿80例.随机将患儿分为血浆组和万汶组,各40例.统计两组患儿性别、年龄、体重、病种、手术切口方式及术前、术后凝血功能7项检测;术前、术后血浆胶体渗透压;术前、术中、改良超滤后、出院红细胞压积;术前、术后血小板计数;术前、术后的血栓弹力图参数;术后24h引流量、呼吸机使用时间、监护室逗留时间、住院时间、术后血浆使用率、术后红细胞使用率、术后凝血酶原复合物使用率.结果 两组患儿均痊愈出院.两组术后胶体渗透压[(14.76±1.33)mm Hg比(14.90±1.02)mm Hg]、凝血反应时间(R)[(8.23±2.28)min比(7.96±13.00)min]、血块形成时间(K)[(4.65±2.27)min比(3.74±2.01)min]、图像开口夹角(Angle)[(44.23±9.12)°比(48.03±8.46)°]、凝血综合指数(CI)[(-6.08±3.22)mm比(-4.78±2.91)mm]、术后血小板[(289.15±102.94)× 109比(300.00±85.66)×109]组间比较均未见统计学差异(P＞0.05).两组术后24h胸引量[(23.00±7.90)ml比(20.75±7.21)ml]、术后血浆使用率(10％比7.5％)、呼吸机使用时间[(19.31±22.59)h比(22.45±25.92)h]、凝血酶原复合物使用率(5.0％比7.5％)、住院时间[(14.27±4.75)d比(13.77±4.82)d]组间比较均未见统计学差异(P＞0.05).结论 采用万汶替代血浆用于婴幼儿体外循环预充,对术后凝血功能未产生显著不利影响,对临床转归无明显影响,未增加患儿术后并发症.婴幼儿先心病手术中万汶可安全用于体外循环预充.%Objective To study the effect of preoperative Voluven perfusion strategy on the coagulation function and clinical outcome of infants after cardiopulmonary bypass,and to evaluate whether it could be safe for infants and young children.To provide a basis for clinical savings in plasma.Methods From February 2017 to May 2017,80 children with congenital heart disease were selected.Children were randomly divided into plasma group and Voluven group,each group included 40 cases.Sex,age,body weight,disease,surgical incision and preoperative coagulation function was counted.We did data statistic on the preoperative and postoperative plasma colloid osmotic pressure,preoperative,intraoperative,after modified ultrafiltration,and the hematocrit in dis-charge,Preoperative and postoperative platelet count,Preoperative and postoperative parameters of thromboelatography;postoperative 24 h drainage,ventilator use time,length of stay in intense care room,length of stay in hospital,postoperative plasma use rate,postoperative hematopoietic cell use rate,postoperative prothrombin complex use rate.Results Children in two groups were healed and discharged from hospital.The postoperative colloid osmotic pressure[(14.76±1.33)mm Hg vs (14.90±1.02)mm Hg],coagulation reaction time(R)[(8.23±2.28)min vs (7.96±3.00)min],blood clot formation time(K)[(4.65±2.27)min vs (3.74±2.01)min],image opening angle(Angle)[(44.23±9.12)° vs (48.03±8.46)°],coagulation index(CI)[(-6.08±3.22)mm vs (-4.78±2.91)mm],PLT count[(289.15±102.94)×109 vs (300.00±85.66)×109] were all have significant difference between the two groups (P＞0.05).The postoperative 24 h drainage [(23.00t7.90)ml vs (20.75±7.21)ml],plasma use rate [(10％) vs (7.5％)],ventilator use time [(19.31±22.59)h vs (22.45±25.92)h],prothrombin complex use rate [(5％) vs (7.5％)],hospital stay time [(14.27±4.75)d vs (13.77t4.82)d] were have no significant difference between the two groups (P＞0.05).Conclusion The use of Voluven instead of plasma for infants and young children after cardiopulmonary bypass did not produce significant adverse effects on the clinical outcome,and this strategy did not increase postoperative complications in children.Infants and young children with congenital heart surgery can safely use this strategy for cardiopulmonary bypass pre-perfusion.
