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《逆行自体血预充对儿童体外循环术后血液成分和肺功能的影响-论文.pdf》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、2264重庆医学2014年6月第43卷第18期论著·临床研究逆行自体血预充对儿童体外循环术后血液成分和肺功能的影响李牧,石泉,王玮,王洋,刘国华,郑民(桂林医学院附属医院心胸外科,广西桂林541001)摘要:目的探讨逆行自体血预充(RAP)对儿童体外循环术后血液成分和肺功能的影响。方法将40例体外循环手术患儿分为RAP组(一2O)和常规预充组(CP组,n:20),分别记录两组患儿的相关指标。结果两组患儿术前各参数比较,差异无统计学意义(P>0.05)。在T2、T。时,RAP组较CP组的RBC计数明显升高(P<0.05);在T。时,RAP组较CP组的wBC计数明显升高(P<0.05
2、);在、T3时,RAP组较CP组的Hb及血细胞比容(HCT)明显升高(P<0.05);与CP组比较,RAP组围术期的用血量以及术后机械通气时间明显减少(P<0.05);而两组的游离Hb、纤维蛋白原(Fib)、PLT及二聚体比较,差异均无统计学意义(P>0.05);在T时,CP组较RAP组的IL~6和IL广8明显升高(P<0.05),T4的炎症反应最强烈;在T2、T3、T时,RAP组较CP组的动态肺顺应性和氧合指数明显升高(P<0.05),而肺泡一动脉血氧分压差明显降低(P<0.05)。结论RAP用于常规体外循环心脏直视手术可减少预充量,降低血液稀释程度,减少临床血用量,同时可以减
3、轻体外循环术后血液有形成分的破坏并能减轻对肺功能的损伤。关键词:体外循环;心脏病;逆行自体血预充;血液成分;肺功能doi:10.3969/).issn.1671—8348.2014.18.003文献标识码:A文章编号:167l_8348(2014)182264—04Ef~ctofretrogradeautologousprimingonbloodcomponentsandpulmonaryfunctioninchildrenaftercardiopulmonarybypassLiMu,ShiQNan,WangWei,WangYang,LiuGuohua,ZhengMin(Depa
4、rtmentofC。rd0£矗Dr。cicSurgery,AffiliatedHospitalofGuilinMedicalCollege,Guilin,Guangxi541001,China)Abstract:ObjectiveTostudytheeffectofretrogradeautologouspriming(RAP)onbloodcomponentsandpulmonaryfunctioninChildrenaftercardiopulrnonarybypass.Methods40childrenpatientswithcardiopulmonarybypasswer
5、erandomizeddividedintotheRAPgroup(n=20)andtheconventionalpriminggroup(CPgroup,n一20).Therelatedindexeswererecordedintwogroups.ResultsTherewerenosignificantdifferencesinthepreoperativeparametersbetweenthetwogroups(P>0.05).However,theRBCcountwassignificantlyhigheratT2andT3intheRAPgroupcomparedwi
6、ththeCPgroup(P%0.05);theWBCcountwassignificantlyhigheratT3intheRAPgroupcomparedwiththeCPgroup(P<0.05)andthelevelsofHCTandHbatT2andTaintheRAPweresignificantlyhigherthanthoseintheCPgroup(P<0.05);theperioperativebloodtransfusionvolumerequirementsandthemechanicalventilationtimeintheRAPgroupweresi
7、gnificantlydecreasedcomparedwiththeCPgroup(P<0.05);PIT,FHb。FibandD-dimerhadnostatisticallysignificantdifferencesbetweenthetwogroups(P>0.05).ThelevelsofIL一6andIL一8atT4intheCPgroupweresignificantlyincreasedcomparedwiththeRAPgroup(P<0.05),theinf
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