小儿体外循环心脏手术中搏动灌注压力衰减的研究

Clinic Study of Pressure Drop during Pulsatile Perfusion in Pediatric Patients undergoing Cardiac Surgery

目的判定改良滚压泵搏动灌注在常规体外循环（extracorporeal circulation,ECC）手术中的有效性并观察不同ECC设备对搏动灌注压力的衰减情况。方法20例法乐四联症（TOF）患儿（男8例,女12例）,平均年龄13.5个月,平均体重10.2 kg。选用两种常用膜式氧合器（各10例）。采用Jostra HL-20型体外循环机行改良滚压泵动脉搏动灌注,所有患儿均在升主动脉阻断期间行搏动灌注,主动脉开放期间行平流灌注。分别监测不同流量状态下不同部位（氧合器入口端、氧合器出口端、动脉插管接头处、挠动脉/股动脉）的压力变化情况。结果搏动灌注期间挠动脉/股动脉有创血压脉压差（ΔP）维持15-35 mmHg。对搏动灌注收缩压衰减最大的是动脉插管（衰减比率72%-73%）,最小的是膜式氧合器（衰减比率22%-24%）;Terumo Capiox RX05产生的氧合器压降在不同流量状态下均小于Dideco Lilliput 902（P〈0.05）。结论Jostra HL-20型体外循环机可以在常规ECC期间产生有效的搏动灌注;动脉插管对搏动血流压力能量的衰减最大;氧合器的压力衰减（OPP）越少将越有利于搏动灌注的能量维持。

OBJECTIVE To evaluate the effectiveness of modified roller pump pulsatile perfusion during conventional extracorporeal circulation（ECC） heart surgery and observe pressure drop caused by different devices in ECC circuit.METHODS 20 pediatric patients diagnosed as tetralogy of Fallot（male 8,female 12） were involved in this clinical pulsatile perfusion study.Mean age was 13.5 months and mean weight was 10.2 kg.Two kinds of oxygenators were used（separate number was 10） in present trial.Jostra HL-20 heart lung machine provided modified roller pump pulsatile perfusion according the inner computer controller.Every patient applied pulsatile perfusion during aorta artery cross-clamping period and roller flat perfusion during cross-clamp off.Three circuit sites（oxygenator inlet,oxygenator outlet and artery cannula connecter site） were arranged pressure detector to measure the pressure during ECC,renal or femoral artery invasive pressure was measured through patient＇s central monitor system.RESULTS Pulse pressure（ΔP） of renal/femoral artery pressure can be maintained between 15 to 35 mmHg during pulsatile perfusion of ECC.The maximum pressure drop happened at artery cannula site in ECC circuit（pressure drop rate was 72%-73%） while minimum pressure drop occurred at oxygenators（pressure drop rate was 22%-24%）.The oxygenator pressure drop（OPP） caused by Capiox RX05 oxygenator was less than that caused by Lilliput 902（P〈0.05） in different pulsatile perfusion blood flow.CONCLUSION Jostra HL-20 heart lung machine can provide effective pulsatile perfusion during conventional ECC.Artery cannula makes the maximum pressure drop during pulsatile perfusion and the less oxygenator pressure drop will be benefit to the maintenance of pulsatile perfusion energy during ECC.