Ootaki Yoshio, Yamaguchi Masahiro, Oshima Yoshihiro, Yoshimura Naoki, Oka Shigeteru
Department of Cardiothoracic Surgery, Kobe Children's Hospital, Hyogo, Japan.
Surg Today. 2002;32(3):203-6. doi: 10.1007/s005950200021.
Modified ultrafiltration (MUF) after cardiopulmonary bypass (CPB) in children has been reported to reduce the need for postoperative blood transfusion and minimize postoperative blood loss. This study was undertaken to quantify the effects of MUF on coagulation factors in pediatric patients.
Seven children scheduled to undergo open-heart surgery for congenital heart defects were studied. CPB circuits were primed with crystalloid solutions and no blood transfusions were performed. Hematocrit, platelet count, total plasma proteins, albumin, fibrinogen, prothrombin, factor VII, factor IX, and factor X were measured preoperatively, at the termination of cardiopulmonary bypass, and at the end of modified ultrafiltration.
MUF was associated with significant (P < 0.05) increases in hematocrit (17.6% +/- 1.6% to 21.6% +/- 2.4%), platelet count 11.1 +/- 2.5 to 12.8 +/- 2.4 x 10(4)/mm3), total plasma proteins (2.7 +/- 0.3 to 3.4 +/- 0.4 g/dl), and albumin (1.6 +/- 0.2 to 2.1 +/- 0.2 g/dl). Fibrinogen, prothrombin, and factor VII also increased significantly (P < 0.05) during MUF, but factor IX and factor X did not change.
We conclude that MUF attenuates the dilutional coagulopathy that occurs during CPB in children. There were slight improvements in the coagulation factors when MUF was employed.
据报道，儿童体外循环（CPB）后采用改良超滤（MUF）可减少术后输血需求并使术后失血量最小化。本研究旨在量化MUF对儿科患者凝血因子的影响。
对7名计划接受先天性心脏病心脏直视手术的儿童进行了研究。CPB回路用晶体溶液预充，未进行输血。在术前、体外循环结束时以及改良超滤结束时测量血细胞比容、血小板计数、总血浆蛋白、白蛋白、纤维蛋白原、凝血酶原、因子VII、因子IX和因子X。
MUF与血细胞比容（从17.6%±1.6%增至21.6%±2.4%）、血小板计数（从11.1±2.5增至12.8±2.4×10⁴/mm³）、总血浆蛋白（从2.7±0.3增至3.4±0.4g/dl）和白蛋白（从1.6±0.2增至2.1±0.2g/dl）的显著（P<0.05）增加相关。在MUF期间，纤维蛋白原、凝血酶原和因子VII也显著增加（P<0.05），但因子IX和因子X未改变。
我们得出结论，MUF可减轻儿童CPB期间发生的稀释性凝血病。采用MUF时凝血因子有轻微改善。
