摘要目的 探讨通过改良设计个性化针对性订制的高分子材料体外循环节血管路(婴儿与成人型)在心脏外科手术中的应用效果与临床预后.方法 41套针对天津市胸科医院心脏外科手术实际情况设计的新型成人(20套)及婴儿(21套)体外循环管路分别应用于成人及10 kg以下婴儿患者(实验组),与使用原有常规型成人(20套)及婴儿(19套)管路患者(对照组)进行临床使用对比,观察两者在预充量、用血量、主泵泵压、血红蛋白(Hb)、游离血红蛋白(f-Hb)、血小板(Pit)计数、混合静脉血氧饱和度(SvO2)与胶体渗透压(COP)水平、乳酸(Lac)水平、拔气管插管时间及重症监护室(ICU)时间等方面的差异.结果 应用新型节血型管路的成人及婴儿患者分别与应用常规管路的成人及婴儿患者比较,预充总量、婴儿预充用血量、术中用血量及f-Hb水平均显著减少,差异均有统计学意义(P＜0.05);而主泵泵压、Hb、Pit、SvO2与COP、Lac水平、停机改良超滤结束后Hb水平、拔气管插管时间及ICU时间等的差异均无统计学意义(P＞0.05).结论 小型化节血型订制高分子材料体外循环管路在维持正常成人与婴儿体外循环心脏手术中血流动力学、氧合与灌注水平的基础上发挥了积极的降低预充量与血制品用量的作用;同时提高了血液相容性,减少了红细胞的破坏,术中术后各项生理指标稳定,手术预后与安全性良好,在体外循环过程中值得推广.

abstractsObjective To explore the blood-saving and conservation effect and clinical prognosis of extracorporeal circulation circuits designed individually by using medical polymeric materials for adults and infants in cardiac surgical procedures.Methods A total of 41 new extracorporeal circulation circuits designed based on the operation requirements,including 20 for adults and 21 for infants,were applied on adults and infants (body weight less than 10 kg),and the results were compared with that of the conventional circuits on adults (20) and infants (19)respectively.Total priming volume,priming and intraoperative blood products consumption,pump pressure,intraoperative blood hemoglobin (Hb) level,free Hb (f-Hb),platelet (Plt) count,mixed venous oxygen saturation (SvO2),colloid osmotic pressure (COP),lactate (Lac) level,Hb level after modified ultrafiltration,endotracheal intubation time and ICU time were all collected in two groups.Results Priming volume,priming and intraoperative blood consumption and f-Hb level in the blood-saving and conservation circuits group were significantly lower than that of conventional circuits group (P＜0.05).There were no significant differences (P＞0.05) between the two groups in pump pressure,intraoperative blood Hb level,Plt,SvO2,COP,Lac level,Hb level after modified ultrafiltration,endotracheal intubation time and ICU time.Conclusions The minimized blood conservation extracorporeal circulation circuit plays an important role in reducing priming volume and blood transfusion.It maintains a normal level of hemodynamics,oxygenation and tissue perfusion level during cardiopulmonary bypass in cardiac surgery for adults and infants.Red blood cell destruction can be reduced by improving blood compatibility,and physical data are all stabilized intra and post operation.This new circuit is secure,with its better outcome,expected in application.