Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management / 中华医学杂志(英文版)

BACKGROUND@#Histidine-tryptophan-ketoglutarate (HTK) is a solution commonly used for organ transplantation. However, there is no certified fixed regimen for on-pump heart surgery in neonates. We aimed to retrospectively evaluate the outcomes related to different HTK dosages and to analyze the safety of high-dosage perfusion.@*METHODS@#A total of 146 neonates who underwent on-pump heart surgery with single-shot HTK perfusion were divided into two groups according to HTK dosages: a standard-dose (SD) group (n = 63, 40 mL/kg 60 mL/kg). Propensity score matching (PSM) was performed to control confounding bias.@*RESULTS@#The SD group had a higher weight (3.7 ± 0.4 vs. 3.4 ± 0.4 kg, P  0.05). The incidences of post-operative complications were not significantly different between the two groups. There were no significant differences in ventilation time, intensive care unit stay, and post-operative hospital stay (P > 0.05). Follow-up echocardiography outcomes at 1 month, 3 to 6 months, and 1 year showed that left ventricular ejection fraction and end-diastolic dimension were comparable between the two groups.@*CONCLUSIONS@#In neonatal on-pump cardiac surgery patients, single-shot HD (>60 mL/kg) HTK perfusion had a comparable heart protection effect and short-term post-operative prognosis as standard dosage perfusion of 40 to 60 mL/kg. Thus, this study provides supporting evidence of the safety of HD HTK perfusion.

Retrospective analysis of 100 patients managed by extracorporeal membrane oxygenation / 中华外科杂志

<p><b>OBJECTIVE</b>To describe the experience with extracorporeal membrane oxygenation (ECMO) for cardiorespiratory support of 100 patients.</p><p><b>METHODS</b>Retrospective analysis of the medical files of 100 patients submitted to the implant of extracorporeal membrane oxygenation system for cardiorespiratory assistance of acute and refractory cardiogenic shock from December 2004 to September 2008. There were 67 males and 33 females, age ranged from 5 d to 76 years with a mean of (28+/-26) years, body mass ranged from 3.8 to 100.0 kg with a mean of (42+/-30) kg. The inter-surface of the ECMO equipment system was completely coated by heparin-coating technique. All patients were applied veno-artery ECMO and activated clotting time was maintained between 120 and 180 s and heparin usage dose was 5 to 20 Uxkg(-1)xh(-1). Mean blood flow was 40 to 220 mlxkg(-1)min(-1) during ECMO assistant period.</p><p><b>RESULTS</b>The shortest ECMO time was 12 to 504 h with a mean of (119+/-80) h. Sixty-one patients (61.0%) weaned off successfully from ECMO, 55 of them (90.2%) were discharged and 6 died of post-operative complications. Thirty-nine patients could not weaned off from ECMO. Total survival discharge rate was 55.0%. Mean aortic pressure before ECMO in survived patients was significantly higher than that of dead patients (P=0.038). Lactic acid concentration of artery blood before ECMO in survived patients was significantly lower than that of dead patients (P=0.005).</p><p><b>CONCLUSIONS</b>ECMO is an effective mechanical assistant therapy method for cardiac and pulmonary failure after cardiac surgery. Earlier usage of ECMO for heart lung failure patient and avoiding the main organs from un-recovery trauma are key success.</p>

Comparative study of pulmonary function after conventional ultrafiltration or modified ultrafiltration during cardiac surgery of infants / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the effects of conventional ultrafiltration and modified ultrafiltration in protecting patients' pulmonary function during cardiopulmonary bypass.</p><p><b>METHODS</b>Thirty infants patients (less than 7 kg) were divided into two groups: conventional ultrafiltration group (CUF, n = 15) and modified ultrafiltration group (MUF, n = 15). The volume of ultrafiltration, transfusion, hematocrit (HCT) before and after ultrafiltration, patients' respiration function (respiration index, A-aDO2, airway pressure), the time of mechanical ventilation and ICU in the two groups were respectively monitored.</p><p><b>RESULTS</b>The transfusion in MUF group was significantly less than in CUF group (P < 0.01), and the volume of ultrafiltration in MUF group was significantly more than in CUF group (P < 0.01). The time of mechanical ventilation and ICU staying in MUF group were significantly shorter in MUF group than that in CUF group (P < 0.05). At 12 and 24 hours after operations, the A-aDO2 in MUF group was lower than that in CUF group (P < 0.05), and the respiratory index in MUF group was higher than that in CUF group (P < 0.05).</p><p><b>CONCLUSION</b>The modified ultrafiltration can effectively improve pulmonary function after operations for low weight infants.</p>