Tsang V T, Mullaly R J, Ragg P G, Karl T R, Mee R B
Victorian Paediatric Cardiac Surgical Unit, Royal Children's Hospital, Parkville, Australia.
Perfusion. 1994;9(4):257-63. doi: 10.1177/026765919400900403.
Between October 1984 and January 1993, seven children of Jehovah's Witnesses underwent corrective open-heart surgery for congenital defects, on cardiopulmonary bypass (CPB). Age at surgery ranged from three months to 6.5 years, and weight ranged from 4.2 kg to 23.2 kg, with two children weighing less than 10 kg. The principal cardiac anomalies were tetralogy of Fallot (two), double outlet right ventricle (one), subaortic stenosis (one), transposition of the great arteries and ventricular septal defect (one), atrial septal defect and congenital heart block (one), and congenital mitral regurgitation (one). Hypothermic CPB was used in all seven operations with crystalloid priming of the extracorporeal circuit. CPB was based on our standard perfusion protocols. All surgical procedures were done without the use of blood or blood products. The mean preoperative haematocrit (Hct) was 40.9% (range 31.0-47.8%). The mean lowest intraoperative Hct was 17.3% (range 15.0-24.3%), whereas the immediate post-CPB Hct was 19.6% (range 15.3-24.0%). The Hct progressively increased to 29.2% (range 21.0-34.2%) on the first postoperative day, and 32.3% (range 24.2-38.3%) at the time of discharge. There was no hospital mortality, and the mean hospital stay was 10 days (8-13 days). We report the safe repair of complex open-heart surgery in children, without blood transfusion, even in small infants. The successful management of these patients requires meticulous attention to surgical and perfusion technique, and sound postoperative management.
1984年10月至1993年1月期间，7名耶和华见证人的儿童接受了先天性心脏缺陷的体外循环心脏直视矫正手术。手术年龄从3个月至6.5岁不等，体重从4.2千克至23.2千克不等，其中两名儿童体重不足10千克。主要心脏异常包括法洛四联症（2例）、右心室双出口（1例）、主动脉瓣下狭窄（1例）、大动脉转位合并室间隔缺损（1例）、房间隔缺损合并先天性心脏传导阻滞（1例）以及先天性二尖瓣反流（1例）。所有7例手术均采用低温体外循环，体外循环回路采用晶体预充。体外循环基于我们的标准灌注方案。所有手术操作均未使用血液或血液制品。术前平均血细胞比容（Hct）为40.9%（范围31.0 - 47.8%）。术中最低平均Hct为17.3%（范围15.0 - 24.3%），而体外循环后即刻Hct为19.6%（范围15.3 - 24.0%）。术后第一天Hct逐渐升至29.2%（范围21.0 - 34.2%），出院时为32.3%（范围24.2 - 38.3%）。无住院死亡病例，平均住院时间为10天（8 - 13天）。我们报告了即使在小婴儿中，不输血进行儿童复杂心脏直视手术的安全修复情况。成功管理这些患者需要对手术和灌注技术给予细致关注以及良好的术后管理。
