轻度贫血简单先天性心脏病患儿无血预充的临床研究

Bloodless cardiac surgery in children diagnosed with simple congenital heart disease and mild anemia

摘要:

目的：探讨对于术前有轻度贫血的简单先心病患儿采用无血预充的安全性及可行性。方法：回顾性分析2014年2月至2016年2月于我院行先天性心脏病根治术治疗的术前有轻度贫血的99名简单先心病患儿[最终分为无血手术组（n=87）和术中输血组（n=12）]的术前一般情况，围术期血气分析情况及术后恢复情况。结果：无血手术组患儿及术中输血组患儿术前一般情况、围手术期血气分析指标均无明显差异，且术后呼吸机辅助通气时间、24 h引流量、ICU停留时间、术后住院时间等无明显差异（P值分别为0.85、0.91、0.22、0.84）。结论：对于术前轻度贫血的简单先心病患儿实施无血手术可节约术中用血，并且对患儿术后恢复情况无明显不良影响，是安全可行的，对于目前提出的无血预充患儿术前尽量纠正贫血至正常的要求可酌情适当放宽，以降低延误病情的风险，同时准确把握无血预充患儿术中输血指征可进一步平衡临床输血与贫血的矛盾，降低临床不合理用血，积极应对血源紧张形势。

Abstract:

Objective：To investigate the security and feasibility of performing bloodless cardiac surgery in children with simple con－genital heart disease（CHD） and mild anemia. Methods：A total of 99 patients，who underwent cardiac surgery in Children Hospital of Chongqing Medical University from February 2014 to February 2016，diagnosed with CHD and mild anemia preoperatively were enrolled and divided into 2 groups on the basis of perioperative blood transfusion. Eighty-seven patients were performed bloodless surgery and 12 patients were not. Major clinical parameters of postoperative period were compared between 2 groups. Results：No sig－nificant difference in ventilation time，24-hour chest tube drainage volume，ICU retention time，postoperative hospital stay（P=0.85，0.91，0.22，0.84，respectively） was observed between the two groups. Conclusion：For children with simple CHD and mild anemia，it’s proven safe and feasible to conduct bloodless surgery. Hemoglobin optimization could have a not so strict standard to balance the risk of progression of disease and preoperative anemia in transfusion-free surgery although many researchers suggest optimizing hemoglobin level at least to normal value. In addition，accurate assessment of anemia and transfusion indication during pediatric car－diac surgery could further reduce allogenic transfusion and relieve blood shortage.