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目的回顾总结应用超滤洗涤优化含血预充液,术中平衡滤过和改良超滤对婴幼儿围体外循环期的影响。方法自2012年1月—2014年10月在河南省胸科医院接受先心病手术治疗的体重在8kg以下婴幼儿共669例。其中494例体重2.5~7kg,采用血液回收机对库存红细胞洗涤后预充;175例体重7~8kg,应用体外循环管道中血液超滤器对含血预充液超滤洗涤15min以优化预充液。所有患儿术中均采用常规超滤和停机后改良超滤。结果 1保存4~20d的库存红细胞:Ph值<6.8,K+(12.3±3.1)mmol/L,Lac+(10.8±3.3)mmol/L,Glu+(19.4±1.12)mmol/L,BE值(-13±-5)mmol/L;经血液回收机洗涤后Ph值(7.41±0.55),K+(3.3±0.9)mmol/l,Lac+(2.3±1.5)mmol/L,BE值(-3±1.2)mmol/L,Glu+(9.11±1.08)mmol/L;应用超滤器洗涤含血预充液后Ph值(7.42±0.58),K+(4.53±1.52)mmol/L,Lac+(1.3±0.44)mmol/L,BE值(-4±1.2)mmol/L,Glu+(9.22±1.02)mmol/L。2全组669例患儿,体外循环开始时均能平稳过渡,无1例转流开始时就出现室颤等心律失常。术中参考患儿胶体渗透压和红细胞压积比(HCT)行常规超滤和改良超滤。所有患儿669例均无出现体外循环相关并发症,痊愈出院。结论应用超滤对含血预充液进行洗涤超滤,同样可以达到应用血液回收机对库存红细胞洗涤的的效果。这两种方案均可以使体外循环预充液更符合患儿生理状态,减少由此引起的电解质紊乱和酸碱失衡,提高围体外循环期安全性。常规超滤和改良超滤的联合应用可快速使患儿的胶渗压和HCT达到合理水平,减少水肿和体外循环后的失血和输血,提高了体外循环的安全性,有利于术后恢复。
OBJECTIVE: To review the effects of ultrafiltration on the optimization of extracorporeal circulation in infants and young children by optimizing blood-containing priming solution, intraoperative balance filtration and modified ultrafiltration. Methods From January 2012 to October 2014, a total of 669 infants under 8 kg of body weight underwent surgery for congenital heart disease in Henan Chest Hospital. Among them, 494 cases were 2.5-7kg in weight, pre-filled with red blood cells after being washed by blood collection machine, 175kg body weight 7-8kg, ultrafiltration washed with blood prefilled liquid with blood ultrafilter in extracorporeal circulation pipe for 15min to optimize prefilled liquid. All children underwent both conventional ultrafiltration and modified ultrafiltration after stopping. Results 1 Preserved stock of erythrocytes from 4 to 20 days: Ph value <6.8, K + 12.3 ± 3.1 mmol / L, Lac + 10.8 ± 3.3 mmol / L, Glu + 19.4 ± 1.12 mmol / ± 5) mmol / L; Ph value (7.41 ± 0.55), K + (3.3 ± 0.9) mmol / L, Lac + (2.3 ± 1.5) mmol / L and BE value (-3 ± 1.2) (7.42 ± 0.58), K + (4.53 ± 1.52) mmol / L, Lac + (1.3 ± 0.44) mmol / L and Glu + (9.11 ± 1.08) mmol / / L, BE (-4 ± 1.2) mmol / L, Glu + (9.22 ± 1.02) mmol / L. 2 The whole group of 669 cases of children, can be a smooth transition at the beginning of CPB, no case of ventricular fibrillation and other arrhythmias occurred at the beginning of the diversion. Intraoperative reference colloid osmotic pressure and hematocrit (HCT) routine ultrafiltration and modified ultrafiltration. 669 cases of children with no complications related to cardiopulmonary bypass were discharged. Conclusion Ultrafiltration of blood prefilled with washing ultrafiltration, the same can be achieved using the blood collection machine on the stock of RBC washing effect. Both programs can make extracorporeal circulation prefilled liquid more in line with the physiological state of children to reduce the resulting electrolyte imbalance and acid-base imbalance and improve the safety of extra-corporeal circulation. The combined application of conventional ultrafiltration and modified ultrafiltration can rapidly increase the osmolality and HCT of infants to a reasonable level, reduce blood loss and blood transfusion after edema and extracorporeal circulation, improve the safety of cardiopulmonary bypass, and facilitate postoperative recovery.