国产膜式氧合器在全胸腔镜微创心脏手术中的应用

Clinical application of domestic membrane oxygenators during minimally inva⁃sive totally thoracoscopic cardiac surgery

目的通过比较国产与进口膜式氧合器在全胸腔镜微创心脏手术中的性能评价指标,为全胸腔镜微创心脏手术中膜式氧合器的选择提供依据。方法2018年11月至2020年5月60例全胸腔镜微创心脏手术患者,按照氧合器的生产地随机分为国产膜式氧合器组(A组n=30,威高7000型)和进口膜式氧合器组(B组n=30,美敦力Affinity),均带有减压阀的密闭式储血罐,两组体外循环(ECC)其他管路组件相同。ECC过程中采用浅低温(肛温32~34℃),灌注流量为60~80 ml/(kg·min),使用空氧混合通气,氧浓度50%~70%,气血比例0.5∶1。心肌保护采用经主动脉根部顺行灌注冷血心肌保护液的方法。于ECC开始前(T1)、ECC开始后15 min(T2)、ECC结束时(T3)采集动脉血气分析,于T1、T2、T3、ECC结束后2 h(T4)、ECC结束后24 h(T5)五个时点采集动脉血检测C反应蛋白、白介素-6等炎性因子,记录ECC管路预充量、停机后余血量、残血量以及术后血管活性药物评分等。结果两组ECC平均转流时间和平均主动脉阻断时间没有显著差异。A组ECC预充量明显大于B组(P<0.05);同样吸氧浓度下,A组与B组氧合器动脉血pH、动脉氧分压和二氧化碳分压、乳酸和血细胞比容组间比较均无统计学差异;两组炎性因子无统计学差异。术后两组患者均无住院死亡。结论带有密闭式储血罐的国产膜式氧合器能够安全有效地应用于全胸腔镜微创心脏手术,尽管没有涂层技术,预充量稍大,其他各项性能同进口同类膜式氧合器无显著性差异。

Objective To explore the clinical application of domestic membrane oxygenators in minimally invasive totally tho⁃racoscopic cardiac surgery by comparing with the imported membrane oxygenators.Methods From November 2018 to May 2020,a to⁃tal of 60 patients undergoing minimally invasive totally thoracoscopic cardiac surgery were randomly divided into the domestic membrane oxygenator group(group A,Wego 7000 adult membrane oxygenator)and the imported membrane oxygenator group(group B,Medtronic Affinity NT adult membrane oxygenator).Both groups had sealed reserviors with positive pressure relief valves and the same pipeline components.The extracorporeal circulation(ECC)with mild hypothermia(rectal temperature 32-34℃)was performed with a flow rate of 60-80 ml/(kg·min),mixed ventilation with oxygen concentration of 50%-70%,and a ratio of gas and blood with 0.5∶1.Myocardial protection was performed by anterograde perfusion of cold-blood cardioplegia through the aortic root.Arterial blood gas was collected for analysis before ECC(T1),15 minutes after ECC(T2),and at the end of ECC(T3).The artery blood samples were taken by 5 time points:T1,T2,T3,2 h after ECC(T4),24 h after ECC(T5)to conduct arterial blood gas analysis(BGA),and to detect inflammatory factors such as c-reactive protein(CRP)and interleukin 6(IL-6),etc.The ECC prime volume,ECC resid⁃ual blood volume,ECC blood loss volume and postoperative vasoactive-inotropic score(VIS)were also recorded.Results There was no significant difference in mean ECC duration and average aortic cross-clamp time between the two groups.The prime volume of ECC in group A was significantly greater than that in group B,P<0.05.Under the same oxygen concentration,there was no statistical differ⁃ence between group A and group B in the pH,PaCO_(2),PaO_(2),Lac and HCT in the oxygenated arterial blood.There was no statistically significant difference in inflammatory factors between the two groups.There were no hospital deaths in either groups after surgery.Con⁃clusion Domestic membrane oxygenators with sealed reserviors can be safely and effectively used in minimally invasive totally thoraco⁃scopic cardiac surgery.Although there is no coating technology and the prime volume is slightly larger,there is no significant difference in the performance with imported membrane oxygenators.