Ando Makoto, Takahashi Yukihiro, Suzuki Natsuko
Department of Pediatric Cardiac Surgery, Sakakibara Heart Institute, Fuchu-si, Tokyo, Japan.
Ann Thorac Surg. 2004 Nov;78(5):1717-22. doi: 10.1016/j.athoracsur.2004.05.006.
To avoid excessive hemodilution, the transfusion of a large amount of homologous blood may be required in open heart surgery for small children, which in turn, can cause a significant immunologic response.
Cardiopulmonary bypass systems with remote pump heads were used for patients weighing 5 kg or less that were undergoing ventricular septal defect repair. The procedures took place from January 1997 to August 2002. The surgery was started with bloodless prime in 122 out of 158 (77.2%) consecutive patients. Exclusion criteria were a predicted hematocrit after the initiation of bypass of less than 15%, respiratory failure or heart failure (or both), and pulmonary vascular obstructive disease.
The mean age and body weight were 3.8 +/- 1.8 months and 4.3 +/- 0.5 kg, respectively. The priming volume was 181.0 +/- 32.5 (minimum: 130) mL. The hematocrit after cardiopulmonary bypass was initiated was 16.7% +/- 2.3%. Six patients required subsequent blood transfusion owing to postoperative complications that resulted in compromised hematopoiesis. In the rest, the hematocrit before discharge was 30.6% +/- 3.0%. Renal and liver function tests were maintained within the normal range. Patients were extubated at 5.6 +/- 2.8 hours after operation with proper oxygenation. Neurodevelopment was apparently normal. The Japanese psychomotor developmental scale assessment was given to patients without chromosomal abnormality between the ages of 1 and 3 years; the resulting score was 102.2 +/- 15.4 (mean = 100 for normal population).
Open heart surgery was achieved without blood transfusion in the selected group of small children. The use of remote pump heads reduced the overall need for blood transfusions and possibly inflammatory reactions.
为避免过度血液稀释，小儿心脏直视手术可能需要输注大量同源血，而这反过来又会引起显著的免疫反应。
对于体重5千克及以下接受室间隔缺损修复手术的患者，使用带有远程泵头的体外循环系统。手术于1997年1月至2002年8月进行。在158例连续患者中，122例（77.2%）手术开始时采用无血预充。排除标准为体外循环开始后预计血细胞比容低于15%、呼吸衰竭或心力衰竭（或两者兼有）以及肺血管阻塞性疾病。
平均年龄和体重分别为3.8±1.8个月和4.3±0.5千克。预充量为181.0±32.5（最小值：130）毫升。体外循环开始后的血细胞比容为16.7%±2.3%。6例患者因术后并发症导致造血功能受损而需要后续输血。其余患者出院前的血细胞比容为30.6%±3.0%。肾功能和肝功能检查维持在正常范围内。患者术后5.6±2.8小时在氧合适当的情况下拔管。神经发育明显正常。对1至3岁无染色体异常的患者进行了日本精神运动发育量表评估；所得分数为102.2±15.4（正常人群平均分为100）。
在选定的小儿群体中实现了无输血心脏直视手术。使用远程泵头减少了总体输血需求，并可能减少了炎症反应。
