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体外循环逆行自体血预充对小儿心脏手术血流动力学参数和肺力学的影响:一项随机临床研究。

Effect of Retrograde Autologous Blood Priming of Cardiopulmonary Bypass on Hemodynamic Parameters and Pulmonary Mechanics in Pediatric Cardiac Surgery: A Randomized Clinical Study.

机构信息

Cardiothoracic Surgery Department, Ain Shams University Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt.

Cardiothoracic Surgery Department, Ain Shams University Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt.

出版信息

Semin Thorac Cardiovasc Surg. 2021;33(2):505-512. doi: 10.1053/j.semtcvs.2020.09.006. Epub 2020 Sep 23.

DOI:10.1053/j.semtcvs.2020.09.006
PMID:32977015
Abstract

The present study aimed to assess the impact of retrograde autologous priming (RAP) on hemodynamics and pulmonary mechanics in children subjected to cardiothoracic surgery. This prospective randomized study analyzed the clinical records of 124 children with risk adjustment in congenital heart surgery-1 left to right lesions subjected to cardiac surgery. They comprised 64 patients in RAP group and 60 patients in the conventional priming group. The preoperative, intraoperative and postoperative data of the studied patients were reported. The outcome measures included hematocrit (Hct) value, blood gases, lung mechanics parameters, transfusion needs, ICU stay, postoperative complications and mortality. Preoperatively, there were no significant differences between the studied groups regarding the demographic data, underlying lesions, laboratory data, blood gases and pulmonary mechanics parameters. Intraoperatively, RAP group patients had significantly lower amount of blood loss, less frequent need to packed red blood cells (RBC)s transfusion and better Hct values when compared with the control group. Postoperatively, RAP group patients had significantly higher Hct% at ICU arrival, significantly better pulmonary mechanics parameters and significantly shorter duration on mechanical ventilation. RAP in children older than 12 months subjected to cardiac surgery for risk adjustment in congenital heart surgery-1 left to right lesions is associated with less transfusion needs and better pulmonary mechanics.

摘要

本研究旨在评估逆行自体预充(RAP)对接受心胸外科手术的儿童血流动力学和肺力学的影响。这是一项前瞻性随机研究,分析了 124 例接受先天性心脏病手术-1 左向右分流风险调整的儿童心脏手术的临床记录。其中 RAP 组 64 例,常规预充组 60 例。报告了研究患者的术前、术中及术后数据。观察指标包括血细胞比容(Hct)值、血气、肺力学参数、输血需求、ICU 停留时间、术后并发症和死亡率。术前,两组在人口统计学数据、基础病变、实验室数据、血气和肺力学参数方面无显著差异。术中,RAP 组患者的出血量明显减少,需要输血的频率明显降低,Hct 值也明显升高。术后,RAP 组患者在 ICU 到达时的 Hct%更高,肺力学参数更好,机械通气时间更短。对于接受先天性心脏病手术-1 左向右分流风险调整的年龄大于 12 个月的儿童心脏手术,RAP 与输血需求减少和更好的肺力学相关。

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