Effects of different temperature rewarming on intraoperative brain protection in children with deep hypothermia circulatory arrest / 中国实用护理杂志

ABSTRACT

Objective:To observe the effect of different temperature rewarming on intraoperative brain protection in children with deep hypothermia circulatory arrest (DHCA).Methods:Totally 24 cases of children undergoing deep hypothermia circulatory arrest under general anesthesia were selected, and randomly divided into 38 ℃ and 43 ℃ groups including 12 cases respectely. Children patients in each group were given forced air rewarming at 38 ℃ and 43 ℃ respectively during the rewarming phase after cross-clamping remission. The age of patients, weight, operation time, intraoperative blood loss, intraoperative fluid infusion and postoperative length of stay were recorded. The arterial blood was taken to determine the serum neuron-specific enolase (NSE) , Platelet activating factor (PAF), and blood lactic acid immediately when the patients were entering into operating room (T 0), before Extracorporeal Circulation (T 1), before aortic cross-clamping (T 2), before DHCA (T 3), rewarming (T 4), temperature to 30 ℃ (T 5), temperature to 33 ℃ (T 6), temperature to 35 ℃ (T 7), CPB was terminated (T 8) and at the end of operation (T 9). And the body temperature were recorded at T 0, T 1, T 3 and T 8. Results:At T 0, T 1, T 3, T 8 and T 9, the temperature difference between the two groups was not statistically significant ( P>0.05). The body temperature first decreased and then increased in the group of 38℃ and 43℃ ( P<0.01). And the serum PAF and NSE significantly increased during the operation ( F values were 5 172.087, 3 535.935, P<0.01). The content of PAF, NSE and lactate in 38 ℃ group and 43 ℃ group increased with time from T 0 to T 9 ( P<0.01).The PAF content of children in the 43℃ group at T 8 and T 9 were (20.34±4.70) μg/L and (25.46±7.75) μg/L respectively, lower than that in the 38℃ group (25.20±3.80) μg/L and (34.97±8.52) μg/L, the differences were statistically significant ( F value was 7.769, P=0.011; F value was 8.193, P=0.009). At T 8 and T 9, NSE content of children in the 43℃ group were (22.13±5.13) μg/L and (28.15±7.90) μg/L respectively, lower than those in the 38℃ group (26.92±3.89) μg/L and (36.57±8.90) μg/L, the differences were statistically significant ( F value was 6.656, P=0.017; F value was 6.012, P=0.023). Blood lactic acid content of children in the 43℃ group at T 4-T 9 respectively (2.77±0.70), (2.93±0.69), (3.13±0.77), (3.39±0.64), (3.77±0.86), (3.83±0.62) mmol/L, lower than 38 ℃ group of children (3.57±0.87), (3.82±0.80), (4.35±0.89), (4.60±0.95), (4.79±0.94), (4.92±0.92) mmol/L, the differences were statistically significant ( F values were 6.125-11.551, P values were 0.022-0.003). Conclusion:Both 38 ℃ and 43 ℃ can ensure that the body temperature of the children increases steadily during the intraoperative rewarming phase in deep hypothermic circulatory arrest operation,but 43℃ can effectively reduce the serum PAF and NSE in children with brain protection, its mechanism may be associated with reduced blood lactic acid.