不同体外循环预充液对婴幼儿血清乳酸水平影响.docVIP

不同体外循环预充液对婴幼儿血清乳酸水平影响 　【摘要】 目的 观察不同预充液对体外循环婴幼儿血清乳酸水平的影响。方法 40例先天性心脏病室间隔缺损合并肺动脉高压的婴幼儿，随机分为A组和 B组,每组各20例。 A组在体外循环中预充勃脉力- A同时施行平衡超滤; B 组在体外循环中预充乳酸钠林格注射液亦施行平衡超滤。同时测定两组婴幼儿术前、CPB 30 min、60 min、停机1 h、术后24 h、术后48 h血清乳酸水平。结果 A组婴幼儿血清乳酸水平在各时点有所上升，但上升不明显(Pgt;0.05); B组在各时点血清乳酸水平显著升高(Plt;0.05)，CPB结束后达最高，之后逐渐下降。结论 勃脉力- A较乳酸钠林格注射液更适用于婴幼儿体外循环预充液。 【关键词】 乳酸;勃脉力-A;体外循环;婴幼儿 　　Abstract: OBJECTIVE To observe the effects of different priming solution on serum lactic acid level of infant during and after cardiopulmonary bypass (CPB). METHODS 40 infants diagnosed congenital ventricle septal defect with pulmonary hypertension were randomly divided into two groups: group A and group B, 20 infants in each group. Using Multiple Electrolytes Injection as priming solution in group A, and Lactated Ringer′s solution in group B during CPB, and balance ultrafiltration performed in both groups. The serum lactic acid level was determined at different time, including before operation, 30 and 60 min after start of CPB, 1 hour after end of CPB, 24 and 48 hours after operation. RESULTS The serum lactic acid level was not increased (Pgt;0.05) in group A, but its level was increased significantly at all time point (Plt;0.05) in group B. The level peaked in the end of CPB and then backed to provious normal level gradually.CONCLUSION Multiple Electrolytes Injection is more suitable than lactated Ringer`s solution as priming solution for infant CPB. 　　Key words： Lactic acid; Multiple Electrolytes Injection; Cardiopulmonary bypass; Infant 　　体外循环(cardiopulmonary bypass,CPB)心内直视术引起机体新陈代谢的紊乱，婴幼儿患者的乳酸变化比成年人更为显著[1]。近年来的研究显示，CPB术后早期，患儿处于高代谢状态是心力衰竭的高发期，此时的高乳酸水平与各种并发症的发生率和死亡率呈正相关关系。本实验分别以勃脉力-A和乳酸钠林格注射液为CPB预充液并采用平衡超滤技术观察婴幼儿围术期的血清乳酸水平。 　　1 资料与方法 　　1.1 临床资料 体重≤10 kg的室间隔缺损合并肺动脉高压的婴幼儿40例。男24例;女16例;年龄26天～2个月。随机分为勃脉力-A组(A组)和乳酸钠林格注射液组(B组)，每组各20例。 　　1.2 方法 两组均采用静脉吸入复合麻醉。体重lt;5 kg者采用Dideco901膜肺，5～10 kg者采用Dideco 902膜肺。A组预充勃脉力-A;B组预充乳酸钠林格氏液。两组均预充5～7天库存浓缩红细胞1 U(避免库血乳酸浓度的差值)，10 g白蛋白，100～表1 两组婴幼儿各时点乳酸水平比较200 ml血浆。连续动态监测混合静脉血氧饱和度并保持在65