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Objective:To evaluate the effects of different electrolyte solutions on blood washing in cardiac surgery with cardiopulmonary bypass (CPB).Methods:Sixty patients, aged 18-80 yr, weighing 50-100 kg, undergoing cardiac surgery with CPB with expected banked blood transfusion 4-6 U in our hospital, were divided into 3 groups ( n=20 each) by a random number table method: compound electrolyte injection group (group A), sodium bicarbonate Ringer′s solution group (group B) and normal saline group (group C). Banked blood and salvaged autologous blood were washed with compound electrolyte injection, sodium bicarbonate Ringer′s solution and normal saline.Banked and autologous blood was collected before washing and immediately after washing for blood gas analysis.The osmotic fragility of red blood cells was measured by colorimetry, and the concentration of 2, 3-diphosphoglycerate (2, 3-DPG) was determined by enzyme-linked immunosorbent assay. Results:Compared with the baseline before washing, the concentrations of K +, Glu and Lac in banked blood were significantly decreased, the concentrations of K + in banked blood were increased, and the concentrations of Glu and Lac in autologous blood were decreased, the osmotic fragility of erythrocytes was increased, and the concentrations of 2, 3-DPG in banked and autologous blood were increased after washing in the three groups ( P<0.05). Compared with group C, the concentrations of Na + and Cl - in banked and autologous blood were significantly decreased, the concentrations of K + in banked and autologous blood were increased, the osmotic fragility of erythrocytes in banked and autologous blood was decreased, and the concentrations of 2, 3-DPG in banked and autologous blood were increased in A and B groups ( P<0.05). Compared with A and C groups, BE in banked and autologous blood were significantly increased after washing in group B than in A and C groups ( P<0.05). After washing, Ca 2+ was detected in banked and autologous blood in group B, however, Ca 2+ was not detected in banked and autologous blood in group A and group C. Conclusions:Compound electrolyte solution and sodium bicarbonate Ringer′s solution provide better efficacy when used for blood washing in cardiac surgery with CPB, and sodium bicarbonate Ringer′s solution can also improve the acidic and calcium-free internal environment of blood.
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Objective:To evaluate the efficacy of bicarbonate Ringer′s solution applied in cardiopulmonary bypass (CPB) in cardiac surgery.Methods:Sixty patients of both sexes, aged 55-75 yr, undergoing cardiac valve replacement under CPB, were selected and randomly divided into compound electrolyte solution group (group A, n=30) and bicarbonate Ringer′s solution group (group B, n=30). Group A was primed with 1 500 ml compound electrolyte solution, group B was primed with 1 500 ml bicarbonate Ringer′s solution, and both groups were primed with 1 000 ml succinylated gelatin.Zero-balanced ultrafiltration was carried out during the rewarming stage.The replacement solution was compound electrolyte solution 2 000 ml in group A, and the replacement solution was bicarbonate Ringer′s solution 2 000 ml in group B. Sodium bicarbonate solution was continuously dripped into an intravenous blood storage tank during CPB, and the acid-base balance disorder was corrected according to the results of blood gas analysis.The peripheral venous blood samples or venous blood samples from the oxygenator were obtained for blood gas analysis before CPB, at 30 min of CPB, at 5 min after opening the ascending aorta for calcium supplementation, at the end of zero-balanced ultrafiltration, and at 5 min after termination of CPB.Venous blood samples were collected from the oxygenator before the start of zero-balanced ultrafiltration and at the end of zero-balanced ultrafiltration for determination of erythrocyte osmotic fragility and concentrations of 2, 3-diphosphoglycerate. Results:Compared with group A, PaCO 2, Ca 2+ and HCO 3-concentrations were significantly increased at 30 min of CPB and at the end of zero-balanced ultrafiltration ( P<0.05), and no significant change was found in pH value, BE, Glu, Lac, serum Na + , Cl - and K + concentrations, erythrocyte osmotic fragility and concentration of 2, 3-diphosphoglycerate in group B ( P>0.05). Conclusion:Bicarbonate Ringer′s solution can be safely and effectively used for CPB in cardiac surgery.
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Objective To discuss the influence on peripheral circulation and oxygenation of different colloid osmotic pressure (COP) in pediatric cardiac surgery under cardiopulmonary bypass (CPB).Methods Sixty cases of non-cyanotic congenital heart disease patients under 10 kg were randomly selected and divided into 3 groups(n =20) according to the different COP level.COP values was adjusted by the ultrafiltration technique and colloid addition.The perioperative(T1-T6) arterial lactate level,different value between skin and rectal temperature,peripheral oxygen saturation (SpO2) and oxygenation index (OI) were observed in order to determine the different effect on peripheral circulation and oxygenation.Meanwhile,mechanical ventilation time and ICU time were recorded.Results The variation tendency of arterial lactate level was similar in each group,the value in the COP ＞ 18 mmHg (1 mmHg =0.133 kPa) group(group C) was significantly higher than COP 10-15 mmHg group (group A) and COP 16-18 mmHg group (group B) in T3 and T4,after CPB weaned,the values of Group A (1.25 ± 0.42) and Group C (1.33 ± 0.51) were higher than Group B (0.71 ± 0.29) at T6 point (P ＜ 0.05);the variation tendency of SpO2 was similar in each group too,the value of group C was significantly lower than group A and B at T5 point,the values of group A and C were significantly lower than group B at T6 point,P ＜ 0.05;the different value between skin and rectal temperature in group A was significantly higher than group B and C from T1 to T2 point(P ＜0.05),but not in T3 to T6 point;The minimal OI values of all the groups were appeared in T4 point,group B value was significantly higher than A and C in all time point,group C value was the lowest(P ＜0.05);the mechanical ventilation time in group B(2.13 ± 1.36) days and group C (2.93 ± 1.69) days were significantly lower than group A (3.83 ± 1.47) days,P ＜ 0.05.ICU time of group B (3.9 ± 1.1) days was significantly lower than group A (5.7 ± 2.5) days and C (6.0 ± 1.5) days.Conclusion During the pediatric CPB,the improper COP level will lead to bad oxygenation and poor peripheral circulation,got different prognosis ultimately.A reasonable COP level(16-18 mmHg) will do benefits to all the pediatric patients.
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Objective 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.
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Objective To study in vitro hydrodynamics of a pneumatic pulsatile ventricular assist device developed ex?clusively by China, and establish an animal model for the detection by the device. Methods The hydromechanics experi?ment was performed on an in vitro test loop using MEDOS-System to drive the ventricular assist device, and lycerl-water so?lution was used as circulating medium. The changes of afterload pressure and the output of the pump were monitored, and the impermeability and stability were also assessed after the experiment. Six adult dogs were used as the experimental animals. The device worked in the left heart assistance mode for 1 hour then the ventricular fibrillation was induced by potassium chloride, and then defibrillated after 5 min while the device remained working. The hemodynamics data were monitored con?secutively during the trial. Results The ventricular assist device worked stably and reliably during the hemodynamic exper?iment. The pump can generate more than 4 L/min flow against the afterload pressure of 100 mmHg. There were no significant changes in heart rate at different time points in experimental dogs after left ventricular assist. Comparison between after auxil?iary immediately and former auxiliary, the diastolic blood pressure of dogs increased 30 mmHg with the ventricular assist, and the diastolic pressure increased 19 mmHg. No obvious fluctuation in blood pressure was found during the auxiliary pro?cess. The diastolic blood pressure stayed at 60 mmHg when the heart was in ventricular fibrillation, and returned to normal after electrical defibrillation. Conclusion The ventricular assist device works stably in vitro test, and the pump can meet the need of adult’s ventricular assist. It is effective and security to dogs in short term. The effects of long-term use need to be future proved.