Clinical Research Of Bloodless Surgery In Pediatric Cardiac Surgery

Objective: We analyze the perioperative data of children with congenital heart disease(CHD)who underwent cardiac surgery in our hospital within recent two years,to verify the feasibility and safety of bloodless cardiac surgery(CS)in children,to avoid the abuse of perioperative blood products,to alleviate the tense situation of shortage of blood resources,and to apply and promote the technique in clinical practice.Methods: According to the inclusion and exclusion criteria,129 patients who accepted radical operation with conventional cardiopulmonary bypass(CPB)in the Department of Cardiothoracic Surgery,Children’s Hospital of Chongqing Medical University from October 2018 to September 2019 were enrolled.Based on the exact occasion,they were divided into transfusion group,bloodless transfusion group and bloodless group,and then divided into weight ≤ 10 kg group(transfusion group 11 cases,bloodless transfusion group 21 cases,bloodless group 11 cases),weight>10kg group(transfusion group 29 cases,bloodless transfusion group 29 cases,bloodless group 28 cases);The differences of various data collected in perioperative period were compared,including general condition before operation,blood gas analysis results during operation,CPB time,aortic cross clamp(ACC)time,ventilation time,postoperative ICU stay,postoperative hospital stay,postoperative 24 h drainage and postoperative 7th d left ventricular ejection fraction(LVEF).Results: In the weight ≤ 10 kg group,there was no statistical difference in preoperative general information,CPB time,ACC time,ventilation time,ICU stay,postoperative hospital stay,postoperative 24 h drainage and postoperative 7thd LVEF between transfusion group,bloodless transfusion group and bloodless group;there were significant differences in Hb and Hct at CPB 30 min,Hct at the end of CPB,APTT at postoperative1 h and Pa O2 at 48 h between the transfusion group and bloodless group;there were significant differences in Hct,APTT and Pa O2 at the end of CPB between bloodless group and bloodless transfusion group.In the weight > 10 kg group,there was no significant difference in preoperative general information,there was no statistical difference in preoperative general information,CPB time,ACC time,ventilation time,ICU stay,postoperative hospital stay,postoperative 24 h drainage and postoperative 7thd LVEF between transfusion group,bloodless transfusion group and bloodless group;there were significant differences in Hb and Hct at the end of CPB,Hb at postoperative 24 h,APTT at postoperative 1h and Hb at postoperative 48 h between transfusion and bloodless groups;there were significant differences in Hct at CPB 30 min,APTT at postoperative 1h,Hb at postoperative 24 h and at postoperative 48 h between bloodless group and bloodless transfusion group.Conclusion: We tend to conclude that it is safe and feasible to perform bloodless cardiac surgery for child with an acceptable level of Hct.,The standard of perioperative blood transfusion in this research can be taken as a reference in clinical practice,to strictly control the indications of blood transfusion,to reduce the clinical use of blood to relieve the current tension of blood resources,to reduce the incidence of transfusion-related adverse reactions and the expense of patients’.