Gurbuz A T, Novick W M, Pierce C A, Watson D C
University of Tennessee-Memphis, Le Bonheur Children's Medical Center, USA.
Ann Thorac Surg. 1998 Apr;65(4):1105-8; discussion 1108-9. doi: 10.1016/s0003-4975(98)00120-9.
Infants and children undergoing open cardiac operations have a high incidence of blood product transfusion. Ultrafiltration has been shown to reverse hemodilution and improve myocardial function and hemodynamics after cardiopulmonary bypass (CPB).
The effect of ultrafiltration on the amount of blood transfusion and hospital charge in 39 consecutive patients who underwent elective atrial septal defect repair was examined. Patients in group I (n=26) had a conventional cardiopulmonary circuit prime with blood, whereas 13 patients had bloodless prime (group II). Ultrafiltration was used immediately after weaning from CPB in group II. The patients in group I received blood products after discontinuation of CPB to achieve a hematocrit of 30%. The amount of blood product used, hematocrit immediately after CPB and on arrival in intensive care unit, postoperative hemodynamics and saturations, total operating room charge, blood charge, hospital stay, and hospital charge were compared.
Mean body weight (15.8 kg in group I versus 17.5 kg in group II) and preoperative hematocrit values (35.6% in group I versus 34.2% in group II) were similar. Mean hematocrit immediately after CPB was 22% and 14% in group I and II, respectively (p < 0.0001). The mean hematocrit upon arrival to the intensive care unit was 34% in group I and 22% in group II (p < 0.0001). The amount of blood product transfusion was 32 mL/kg in group I and 3 mL/kg in group II patients (p < 0.0001). The patients in group II had significantly less blood bank charges; however, operating room charges and total hospital charges were similar between the two groups.
Elective atrial septal defect repair was performed with no blood product transfusion without increased morbidity or hospital stay. Ultrafiltration can be used to reverse hemodilution resulting from a bloodless CPB prime without an increase in hospital charge.
接受心脏直视手术的婴幼儿输血发生率很高。超滤已被证明可逆转血液稀释，并改善体外循环（CPB）后的心肌功能和血流动力学。
研究了超滤对39例连续接受择期房间隔缺损修复术患者的输血量和住院费用的影响。第一组（n = 26）患者采用常规血液预充体外循环回路，而13例患者采用无血预充（第二组）。第二组在脱离CPB后立即使用超滤。第一组患者在CPB停止后接受血液制品以达到30%的血细胞比容。比较了两组患者的血液制品使用量、CPB后及进入重症监护病房时的血细胞比容、术后血流动力学和饱和度、手术室总费用、血液费用、住院时间和住院费用。
两组患者的平均体重（第一组为15.8 kg，第二组为17.5 kg）和术前血细胞比容值（第一组为35.6%，第二组为34.2%）相似。第一组和第二组CPB后即刻的平均血细胞比容分别为22%和14%（p < 0.0001）。进入重症监护病房时第一组和第二组的平均血细胞比容分别为34%和22%（p < 0.0001）。第一组患者的血液制品输血量为32 mL/kg，第二组患者为3 mL/kg（p < 0.0001）。第二组患者的血库费用明显较低；然而，两组之间的手术室费用和总住院费用相似。
择期房间隔缺损修复术可在不输血的情况下进行，且不增加发病率或住院时间。超滤可用于逆转无血CPB预充导致的血液稀释，且不增加住院费用。
