Friesen R H, Campbell D N, Clarke D R, Tornabene M A
Department of Anesthesiology, The Children's Hospital, University of Colorado, Denver 80218, USA.
Ann Thorac Surg. 1997 Dec;64(6):1787-9. doi: 10.1016/s0003-4975(97)00921-1.
Extreme hemodilution caused by relatively large prime volumes required for cardiopulmonary bypass in infants causes a dilutional coagulopathy, characterized by low concentrations of fibrinogen and other circulating coagulation factors. Modified ultrafiltration results in hemoconcentration and is associated with decreases in postoperative bleeding and transfusion requirements in children. This study was undertaken to quantify the effect of modified ultrafiltration on concentrations of fibrinogen, plasma proteins, and platelets in infants and small children.
Twenty patients less than 15 kg were studied. Cardiopulmonary bypass circuits were primed with crystalloid solutions. Red blood cells were added during cardiopulmonary bypass for hematocrits less than 15%. Colloid solutions were not administered. Concentrations of fibrinogen, plasma proteins, and platelets, and hematocrit were measured before cardiopulmonary bypass, before modified ultrafiltration, and after modified ultrafiltration.
Modified ultrafiltration was associated with significant (p < 0.001) increases in hematocrit (19% +/- 6% to 31% +/- 9%), fibrinogen (65 +/- 29 to 101 +/- 45 mg/dL), and total plasma proteins (2.7 +/- 0.3 to 4.9 +/- 0.7 g/dL), but no change (p = 0.129) in platelet count.
We conclude that modified ultrafiltration significantly attenuates the dilutional coagulopathy associated with cardiopulmonary bypass in infants.
婴儿体外循环所需的相对大量预充液导致的极度血液稀释会引起稀释性凝血病，其特征为纤维蛋白原和其他循环凝血因子浓度降低。改良超滤可导致血液浓缩，并与儿童术后出血减少和输血需求降低相关。本研究旨在量化改良超滤对婴幼儿纤维蛋白原、血浆蛋白和血小板浓度的影响。
对20例体重小于15kg的患者进行研究。体外循环回路用晶体溶液预充。当血细胞比容低于15%时，在体外循环期间添加红细胞。未给予胶体溶液。在体外循环前、改良超滤前和改良超滤后测量纤维蛋白原、血浆蛋白和血小板的浓度以及血细胞比容。
改良超滤与血细胞比容显著升高（从19%±6%升至31%±9%，p<0.001）、纤维蛋白原升高（从65±29mg/dL升至101±45mg/dL）和总血浆蛋白升高（从2.7±0.3g/dL升至4.9±0.7g/dL）相关，但血小板计数无变化（p=0.129）。
我们得出结论，改良超滤可显著减轻婴儿体外循环相关的稀释性凝血病。
