微小化体外循环管路减少新生儿及小婴儿术中用血及炎性反应

Minimizing extracorporeal circulation circuit in neonates and young infants undergoing cardiac surgery

目的通过微小化新生儿及小婴儿(小婴儿定义为年龄小于3个月或体重小于5 kg的婴儿)体外循环(ECC)管路,减少ECC预充量,以期减少术中用血量及炎症反应。方法将40例在ECC下行心内畸形矫治术的新生儿及小婴儿随机分为例数相同的两组,对照组(n=20)采用StockertⅢ型人工心肺机、婴儿型膜肺、1/4英寸管道、改良超滤套包、婴儿型动脉滤器,总预充量约410 ml;实验组(n=20)采用带外挂一大泵头及一组小泵头的StockertⅢ型人工心肺机、婴儿型膜肺、3/16英寸管道、改良超滤套包、不用动脉滤器,总预充量约290 ml。ECC中保持Hct在0.27～0.32。观察:①术中用血量;②ECC前后炎性细胞因子白介素(IL)-6、IL-8及肿瘤坏死因子-α(TNF-α)的变化;③术中混合脑氧饱和度(rSO2)、术后清醒时间及神经系统状况。结果①术中用血量小于等于2 u在实验组为16例(80%),对照组6例(30%),组间比较P<0.01。②术毕IL-6实验组(43.3±19.1)ng/ml显著低于对照组(57.8±28.9)ng/ml,P<0.05;术后4 h IL-8实验组(72.6±31.3)ng/ml显著低于对照组(94.4±44.7)ng/ml,P<0.05。③两组患儿术中rSO2无显著差异,术后清醒时间、神经系统状况无显著差异。结论微小化ECC管路能减少新生儿及小婴儿心脏手术中用血量、减少炎性反应,新生儿及小婴儿ECC管路应尽量微小化。

OBJECTIVE To determine the effects of minimizing extracorporeal circulation（ECC） priming volume for neonates and young infants（young infants defined as age less than 3 months or weight less than 5 kg）on reducing exposures to exogenous packed red blood cells（PRBC） and perioperative inflammation reactions.METHODS 40 neonates or young infants suffering from congenital heart disease undergoing open heart surgery were put into 2 groups randomly： group A（control group,n=20）,ECC circuit consists of a 1/4 inch arterial and venous line,infant oxygenator,modified ultrafiltration and infant arterial filter with 410 ml total circuit prime;group B（study group,n=20）,ECC circuit consists of a 3/16 inch arterial and venous line,infant oxygenator,modified ultrafiltration and no arterial filter with 290 ml total circuit prime.PBRC transfused during operation were recorded.Blood samples were drawn from central venous line before bypass,at the end of operation,4 hours and 24 hours postoperatively for measuring IL-6,IL-8 and TNF-a.INVOS 5100 was used during the operation for monitoring rSO2.Postoperative neurological results were also recorded.RESULTS In group B,16 were exposed to two or less intraoperative exogenous PRBC unites while only 6 in group A received two or less（P0.01）.Before bypass and 24 h after operation,the IL-6,IL-8 and TNF-a between the two groups are similar.At the end of operation IL-6（ng/ml） in group B is significantly lower than that of group A（43.3±19.1 vs 57.8±28.9,P0.05）.At 4 h after operation,IL-8（ng/ml） in group B is significantly lower than that of group A（72.6±31.3 vs 94.4±44.7,P0.05）.There is no significant difference between the two groups as to rSO2 and postoperative neurological results.CONCLUSION For neonates and young infants undergoing open heart surgery,decreasing the circuit priming volume by 120ml results in significantly fewer multiple exposures to exogenous PRBC units and reducing inflammation reactions without effects on postoperative neurological results.