曹 倩，王葵亮，任立彦，刘 玮，张 蓓，王鲁甬，邢泉生



整合式膜式氧合器在新生儿少血预充中的作用

曹 倩，王葵亮，任立彦，刘 玮，张 蓓，王鲁甬，邢泉生

［摘要］：目的 试从多角度探讨现有新生儿体外循环装置各环节的整体作用及研发空间。方法 选取2015年1月至6月在本院行先天性心脏病根治术的足月新生患儿40例,体重3.1～4.3 kg,随机分为两组,T组(n＝20):使用内置动脉微栓滤器的整合式膜式氧合器(膜肺)；M组(n＝20):使用普通膜肺联合外置的动脉微栓滤器。两组均使用定制的国产Ф4新生儿迷你管路及静脉负压辅助装置。两组均添加适量红细胞以维持转中红细胞比容0.25左右,均不用血浆。比较两组的静态预充量、库血预充量、库血使用总量及膜肺自身个性特点。结果 T组的最低静态预充量为135 ml,显著低于M组( P＜0.05),红细胞预充量、红细胞使用总量也较M组明显减少；术前备血T组仅需1 U,M组则需2 U( P＜0.05)。虽然两组膜肺的自身预充量无差异,但在临床灌注医师精确静脉还血的指导性、Ф4迷你管路连接的依从性方面,T组略优于M组。国内、外所有的各种体外循环插管、氧饱和度管等最细直径均为1/4″,与Ф4迷你管路不匹配。结论 综合使用新型膜肺、Ф4迷你管路等新型体外装置可以做到新生儿少血预充。传统的体外循环产品尚需继续配套化、规范化、迷你化、商业化,协助实现新生儿无血预充目的。

［关键词］：体外循环；新生儿；无血预充

The entirety effects of new devices for blood less extracorporeal circulation in neonates

Cao Qian,Wang Kui-liang,Ren Li-yan,Liu Wei,Zhang Bei,Wang Lu-yong,Xing Quan-sheng
Qingdao Children＇s Heart Center,Qingdao Women and Children＇s Hospital ,Congenital Heart Diseases
Research Center of Qingdao University,Qingdao 266034,China
Corresponding author:Xing Quan-sheng,Email:qsxing@ 163.com

［Abstract］：Objective To explore the entirety effects and future development of neonatal extracorporeal circulation(ECC) products from a multi-angle perspective.Methods Forty full-term newborns with congenital heart disease,weighed from 3.1 kg to 4.3 kg,were divided into two groups.In group T(n＝20) ,the newest oxygenators incorporating an arterial line filter were used.In group M(n＝20) ,the common oxygenators and external arterial line filters were used together.The customized domestic Ф 4 neonatal mini circuit and vacuum assisted venous drainage(VAVD) were used in both groups.Red blood cells were added to achieve a Hct of 0.25 during ECC in both groups.Static priming volume,priming and total volume of red blood cells,and the personality characteristics of oxygenators were compared in two groups.Results The minimum static priming volume in group T,which was 135 ml,significantly lower than that of group M( P＜0.05).The priming volume and total volume of red blood cells were significantly reduced in group T；Preoperative preparation of red blood cells was only 1 U in group T ,but 2 U in Group M( P＜0.05).Although the volume of oxygenator in two groups was not different,but the precise scale and the Ф 4 mini circuit connection were slightly better than those of group M.The minimum size 1/4＂in diameter in all kinds of ECC cannula at home and abroad didn＇t match with the Ф4 neonatal mini circuit.Conclusion Bloodless ECC in neonates could be achieved by comprehensive use of the newest oxygenators and the Ф4 neonatal mini circuit.Traditional ECC products still need to upgradeto form a complete matching,standardization,minimalization,and commercialization in order to achieve neonatal bloodless ECC.

［Key words］： Extracorporeal circulation；Neonate；Bloodless

异体血制品对患者机体的危害与风险被越来越重视[1]。体外循环的大预充大稀释是婴幼儿、尤其新生儿先天性心脏病患者常规使用大量异体血制品预充的主要原因。……