Procelewska Małgorzata, Januszewska Katarzyna, Kołcz Jacek, Mroczek Tomasz, Kral Artur, Stycuła Wojciech, Stebel Adam, Malec Edward
Klinika Kardiochirurgii Dzieciecej, Katedry Chirurgii Pediatrycznej, Polsko-Amerykańskiego Instytutu Pediatrii, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie.
Przegl Lek. 2004;61(3):146-51.
Pediatric open heart surgery is associated with the usage of cardiopulmonary bypass. The circuit is primed with blood products because of risk of excessive hemodilution. The aim of the study was to prove the safety of open heart surgery on cardiopulmonary bypass without the use of blood products in the pediatric group. In this study, 78 patients with atrial septal defect (ASD type II) were enrolled and underwent elective atrial septal defect repair between the years of 1999 and 2003. The group I included 37 children aged from 3 to 16 years (8.79 +/- 4.45) who weighed from 13 to 68.8 kg (29.93 +/- 15.00). In this group, the transfusion of blood products during the surgery and postoperative course was avoided. Blood products were used in a control group (group II 4.1 patients) both during and after surgery. Children from this population ranged in age from 2.5 to 17 years (8.41+/- 4.18) and weighed from 11.5 to 59.7 kg (26.99 +/-12.95). For statistical analysis the t-Student test and U Mann Whitney test were used. The length of stay in the intensive care unit (1.18 +/- 0.47 vs 1.20 +/- 0.61 days) and total hospital stay (8.91 +/- 3.05 vs 10.05 +/- 4.28 days) did not differ statistically between the groups. Values of haematocrit and hemoglobin levels were statistically lower in group I during the postoperative course compared to the control group (intraoperative Hct: 19.43 +/- 4.93 vs 23.37 +/- 4.68%, p < 0.001), but these levels did not correlate with the occurrence of hypoxic, neurologic or coagulation complications. Directly after the surgery, group I had significantly higher platelet and leucocyte counts compared to the control group. There were no differences between the confronted populations in regard to postoperative bleeding (4.61 +/- 2.24 vs 4.76 +/- 1.75 ml/kg). The avoidance of using blood products in pediatric patients during open heart surgery with cardiopulmonary bypass is found to be safe, is not correlated with an increased surgical risk, and does not result in a prolonged hospital stay.
小儿心脏直视手术与体外循环的使用相关。由于存在过度血液稀释的风险，体外循环回路要用血液制品预充。本研究的目的是证明在小儿群体中，不使用血液制品进行体外循环心脏直视手术的安全性。在本研究中，纳入了78例房间隔缺损（II型房间隔缺损）患者，并于1999年至2003年间接受了择期房间隔缺损修复术。第一组包括37名年龄在3至16岁（8.79±4.45）、体重在13至68.8千克（29.93±15.00）的儿童。该组在手术及术后过程中避免输注血液制品。对照组（第二组41例患者）在手术期间及术后均使用了血液制品。该组儿童年龄在2.5至17岁（8.41±4.18），体重在11.5至59.7千克（26.99±12.95）。采用t检验和U曼-惠特尼检验进行统计分析。两组在重症监护病房的住院时间（1.18±0.47天对1.20±0.61天）和总住院时间（8.91±3.05天对10.05±4.28天）上无统计学差异。与对照组相比，第一组术后过程中的血细胞比容和血红蛋白水平在统计学上较低（术中血细胞比容：19.43±4.93对23.37±4.68%，p<0.0
