机械循环辅助对术后患者血浆游离血红蛋白的影响

The Effect of Mechanical Circulation Support Devices on Free Plasma Hemoglobin after Operative Patients

目的研究体外膜式氧合器(extracorporeal membrane oxygenation,ECMO)氧合疗法、BVS5000、AB5000和MEDOS等不同机械辅助装置辅助对术后患者血浆游离血红蛋白(FHb)的影响。方法2004年3月～2005年12月间,20例心脏病术后患者在阜外心血管病医院接受机械循环辅助治疗,根据在辅助治疗期间所使用辅助装置类型的不同分为4组,ECMO组9例,BVS5000组8例,MEDOS组2例,AB5000组1例;随机选取同期9例体外循环手术患者和9例非体外循环冠状动脉旁路移植术患者作为对照(对照组),监测、对比分析其血浆FHb、胆红素、肌酐、尿素氮等指标的变化。结果术中体外循环所致的血浆FHb升高在术后1d内可降至正常。使用机械循环辅助后,除BVS5000组在辅助2d后血浆FHb渐恢复正常外,其余类型的辅助治疗组在整个辅助期间血浆FHb均高于正常;BVS5000组从开始辅助第3d起,血浆FHb浓度明显低于ECMO组(P<0.05)。而ECMO组在辅助中,辅助流量≤2.5L/min的患者FHb有低于辅助流量>2.5L/min的趋势。大多数患者在辅助期间胆红素、尿素氮均有升高,撤除辅助装置后下降。结论运用ECMO,BVS5000,AB5000和MEDOS机械循环辅助装置均会导致一定程度的血液破坏,引起FHb、胆红素增高,但基本都在可接受的范围;其中BVS5000辅助装置对术后患者血浆FHb的影响较其它几种偏小。

Objective To study the impact of different kinds of mechanical circulation support devices on plasma free hemoglobin （FHb）. Methods From Mar. 2004 to Dec. 2005, 20 patients received mechanical circulation support in Fu Wai Hospital, who were divided into 4 groups according to the different type of supporting devices. 9 got extracorporeal membrane oxygenation （ECMO） treatment, 8 received BVS5000 left ventricular support, 2 got MEDOS left ventricular support and 1 received AB5000 left ventricular support. Random control group included 9 cardiotomy patients after CPB supporting and 9 patients with off-pump coronary artery bypass grafting during the same period. Parameters such as FHb, Tbil, Dbil, Cr and BUN were monitored throughout the supporting term. The results were compared according to the different types of mechanical circulation support devices. Results The elevation of FHb caused by CPB could be decreased to normal within ld. However, in BVS5000 group, the elevated FHb level decreased to normal till 2 days later. The others mechanical circulation support devices such as ECMO, MEDOS, AB5000 elevated the FHb throughout the whole supporting period. Compared with those in ECMO group, the patients in BVS5000 group had obviously lower level of FHb since the third day after the beginning of supporting. In patients who got ECMO treatment, there was a trend that the elevation degree of FHb was lower in those with support flow rate less than 2. 5 L/min. For most patients got devices support, there was also an elevation of Tbil and BUN level during the supporting period. Conclusion Mechanical circulation support devices, such as ECMO, BVS5000, MEDOS and AB5000, can cause red cell destruction in acceptable level. BVS5000 has much smaller impact on cell destruction than others do in post-operative patients.