中国体外循环杂志Issue(4)：201-205,209,6.DOI:10.13498/j.cnki.chin.j.ecc.2014.04.03
比较三种胶体液用于婴幼儿体外循环预充的临床效果
Comparison of three different colloids solution for pump priming in infant pa-tients undergoing heart surgery
苗晓蕾 1王旭 2林茹 3舒强 3刘晋萍 1崔勇丽 1赵明霞 1冯正义 1赵举 1龙村 1李守军 2晏馥霞4
作者信息
- 1. 100037北京，中国医学科学院，北京协和医学院，国家心血管病中心，阜外心血管病医院，心血管疾病国家重点实验室，体外循环科
- 2. 100037北京，中国医学科学院，北京协和医学院，国家心血管病中心，阜外心血管病医院，心血管疾病国家重点实验室，心脏外科
- 3. 浙江大学医学院附属儿童医院
- 4. 100037北京，中国医学科学院，北京协和医学院，国家心血管病中心，阜外心血管病医院，心血管疾病国家重点实验室，麻醉科
- 折叠
摘要
Abstract
Objective The aim of this study is to observe the safety and clinical efficiency of three different colloids solution in the circuit priming for infant patients less than 15 kg undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods One hundred and twenty infant patients were randomly divided into 3 groups according to the kind of colloid solutions used in CPB. 6%hydroxyethyl starch 130/0.4 (Voluven), 4%succinylated gelatin (Gelofusine) or fresh frozen plasma were used in CPB circuit prime re⁃spectively. We used thromboelastography ( TEG) to evaluate the hemostatic function after anesthesia induction and 15 min after protamine administration. The postoperative renal and liver function, blood loss volume, blood products usage and recovery time, including mechani⁃cal ventilation time, ICU length of stay and hospitalization time, were also compared among the three groups. Results All cases recov⁃ered smoothly, and without re-open thoracotomy. No patient developed severe renal or liver dysfunction. The colloid osmotic pressure (COP) of the priming solution was higher in Gelofusine or Voluven group than in plasma group (10.2±2.8 vs 9.8±2.7 vs 7.6±2.5, P<0.05). However, the COP measured before or after bypass was comparable among the three groups ( P>0.05). Compared with the preoperative levels, R values from TEG test were all increased while other parameters were all decreased in the three groups after prota⁃mine administration. After heparin reversal, significantly higher functional fibrinogen levels ( FLEV) and MAf value were shown in plasma group compared with the other two groups ( P<0.01) . There were no differences among the three groups in postoperative clot⁃ting factor level, platelet function and the final clotting strength. The postoperative bleeding, blood products dosage and recovery time were all at the similar level among the three groups ( P>0.05) . Conclusion Artificial colloids like Voluven and Gelofusine have com⁃parable effect with plasma in postoperative hemostatic function maintenance. Replacement of plasma with artificial colloids in CPB cir⁃cuit prime could be safe and effective. We can use TEG to test the postoperative hemostatic function and guide the transfusion protocol after cardiac surgery in infant patients.关键词
体外循环/婴幼儿/预充液/人工胶体/血栓弹力图Key words
Cardiopulmonary bypass/Pediatric/Priming solution/Artificial colloids/Thromboelastography引用本文复制引用
苗晓蕾,王旭,林茹,舒强,刘晋萍,崔勇丽,赵明霞,冯正义,赵举,龙村,李守军,晏馥霞..比较三种胶体液用于婴幼儿体外循环预充的临床效果[J].中国体外循环杂志,2014,(4):201-205,209,6.
