ABSTRACT
Objective To explore the effect of different processing techniques to priming and the prognosis in infants dur-ing cardiac surgery under cardiopulmonary bypass(CPB).Methods 90 cases of pediatric patients under 5kg undergoing CPB open heart surgery were randomly selected, in group A(n=30), stored blood was added to the reservoir after crystalloid prim-ing, then zero balanced ultrafiltration(ZBUF) for the mixed priming solution; in group B(n=30), stored blood was cleaned by cell saver first, then added to the reservoir; in group C(n=30) , ZBUF technique was combined with cell saver for the priming.Modified ultrafiltration(MUF) was set up afer weaning bypass in all three groups, crystalloid solution was added to the reservoir to replace the residual blood to the patients.The general information, the quality and processing time of the mixed priming solution, the lactate level, free hemoglobin(f-Hb), inflammatory factor(IL-6/TNF-α) from T0 to T4, the positive ino-tropic drug lasting time , mechanical ventilation time and ICU time were all recorded .Results There were no statistical differ-ences among 3 groups for general condition.The lactate, f-Hb, IL-6 and TNF-αlevel in B and C group from T1 to T4 was sig-nificantly lower than A group , but no statistical meaning between B and C group .B and C group can significantly reduced the positive inotropic drug lasting time , mechanical ventilation time and ICU time .Conclusion To infants, blood priming pretrea-ted by cell saver can improve the quality of blood protection significantly than traditional ZBUF , also get labor saving and time saving effects, finally improve the prognosis.
ABSTRACT
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.
ABSTRACT
0.05),but the level of P- selectin in treatment group were obviously decreased compared with control group after the seventh and fourteenth day(P