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目的:探讨婴幼儿体外循环心脏手术中,不同血液稀释度对体外循环的影响及经济学评价。方法:将40例接受房间隔缺损和室间隔缺损的患儿分为实验组和对照组,每组20例。实验组接受深度血液稀释,对照组接受中度血液稀释[稀释度根据红细胞比容(HCT)分为中度稀释:HCT 0.25～0.29;深度稀释:HCT 0.20～0.25],分析体外循环心脏手术过程中不同血液稀释度对体外循环的影响,并对医疗费用进行经济学评价。结果:2组术中15min时HCT、尿量、预充库血,术后12～24h尿量均差异有统计学意义(均P<0.05),而术中体外循环时间、主动脉阻断时间、停机时HCT,术后HCT、12h尿量、引流量、患者清醒时间及住院时间等均差异无统计学意义。与对照组比较,试验组术中药品费用、血液制品费用和材料费用,术后治疗费用、血液制品费用和住院总费用均明显降低(均P<0.05)。结论:婴幼儿体外循环中深度血液稀释对心脏手术无明显的影响,但可以较大程度地降低医疗费用。
Objective: To investigate the impact of different hemodilution on cardiopulmonary bypass during cardiopulmonary bypass in infants and young children and its economic evaluation. Methods: 40 cases of atrial septal defect and ventricular septal defect were divided into experimental group and control group, 20 cases in each group. The experimental group received deep hemodilution, and the control group received moderate hemodilution [dilution according to hematocrit (HCT): moderate dilution: HCT 0.25-0.29; deep dilution: HCT 0.20-0.25] In different blood dilution on cardiopulmonary bypass, and the medical costs of economic evaluation. Results: There were significant differences in HCT, urine output, blood pooling before delivery and urine volume at 12 ~ 24h after operation at 15min in both groups (all P <0.05), while the time of cardiopulmonary bypass, the time of aortic blockage , HCT downtime, postoperative HCT, 12h urine output, drainage, patients with awake time and hospital stay were not statistically significant. Compared with the control group, the cost of medicine, blood products and materials, the postoperative treatment cost, the cost of blood products and the total cost of hospitalization in the experimental group were significantly decreased (all P <0.05). Conclusion: Deep hemodilution during cardiopulmonary bypass has no obvious effect on cardiac surgery, but it can reduce medical costs to a great extent.