临床评估五种膜式氧合器在不同温度下的跨膜压差

Evaluate the Trans-membrane Pressure Drop of Five Type Membrane Oxygenator in Different Temperatures

目的评估五种中空纤维膜式氧合器(HFMO)在体外循环(CPB)中不同温度下的跨膜压差(TMPD)。方法40例择期CPB下行心脏直视手术患者依据使用HFMO的不同随机分为五组(每组8例):A组(Affinty),C组(Cobe),J组(Jostra),P组(Polystan)和T组(Terumo)。在CPB全流量后(T1)、最低温度时(T2)、复温后(T3)监测灌注流量、鼻咽温度、红细胞比积、平均动脉压,并在HFMO的入口和出口处监测压力的变化。结果各组术前的临床参数没有显著性差异(P>0.05)。TMPD在不同的时点J组为最小,其他依次分别为A组<P组<T组<C组,J组和A组与其他三组相比均较小(P<0.01),且J组在T2时点明显低于A组(P<0.01),P组在T1时点明显低于C组(P<0.01)外,在其他时点各组间相比没有显著性差异(P>0.05)。A组、P组和T组在低温过程中的TMPD分别高于T1和T3,但没有显著性差异(P>0.05)。结论J组和A组的TMPD较低可能更有利于减少对血细胞的破坏,更适合应用于CPB时间较长的心脏手术。

OBJECTIVE To evaluate five type commercial available oxygenators of the trans - membrane pressure drop （TMPD） during normothermic and hypothermic cardiopulmonary bypass （CPB）. METHODS Forty patients scheduled for cardiac surgery participated this study and were divided into five groups （ n = 8 ,in per - group） according to type of oxygenators used during CPB： group J （Joatra Quardox）, group A （Affinity NT）, group P （Polystan Safe Maxi ）, group T （Terumo Capiox SX） and group C （COBE APEX -TM）. Parameters were collected during CPB including mean arterial pressure, pump flow, temperature, hematecrit and TMPD at pre - and post -oxygenator during normothermic（T1 ）, hypot- hermic,28 ℃ （T2） and after rewarming （T3）. RESULTS There was no significant difference among five groups in pre - operative clinical parameters （ P 〉 0.05）. TMPDs of group J were the lowest in different time - points, followed by the other group were group A 〈 group P 〈 group T 〈 group C. TMPD of group J and A compared to the other three groups were lower （ P 〈 0.01 ） respectively and J was significant lower than group A at T2 （ P 〈 0.01 ）. Except TMPDs of group P were significantly lower than group C （ P 〈 0.01 ） at T1, there were no statistical significance （ P 〉 0.05） in various time -points. Although TMPDs in group A, P and T during T2 were higher than T1 and T3, but there were no statistical significance （ P 〉 0.05） in various time - points. CONCLUSION The TMPD of HFMOs in group J and A produced significantly lower and during normothermic and hypothermic CPB, thus blood trauma with these two HFMOs during CPB may be significantly lower compared to the other three.