Mavroudis C, Ebert P A
Department of Surgery, University of California, San Francisco, San Francisco, California, USA.
Circulation. 1978 Sep;58(3 Pt 2):I155-9.
Cardiopulmonary bypass and hemodilution in the newborn have been associated with increased myocardial edema, which may be due to immature connective tissue formation. Five adult and four puppy dogs were placed on bypass while compliance and ventricular function (intraventricular balloon) were measured during normohemoconcentration (NH) (hematocrit 45.1, osmolality 307) and hemodilution with normal saline (hematocrit 24.7, osmolality 307). Compared with NH, the adult group showed no change in compliance or function after 90 min of hemodilution. The puppy group showed a marked decrease in compliance with hemodilution compared to NH (P < 0.001) without change in ventricular function when peak systolic pressure was plotted against end-diastolic volume. Electron micrographs confirmed greater edema formation in the puppy group than the adult group with hemodilution. These changes demonstrate that the newborn heart is more sensitive to edema formation than the adult during hemodilution and that filling pressures do not necessarily reflect ventricular performance during the early post-perfusion period when compliance is decreased.
新生儿体外循环和血液稀释与心肌水肿增加有关，这可能是由于结缔组织形成不成熟所致。五只成年犬和四只幼犬接受体外循环，在正常血液浓缩（NH）（血细胞比容45.1，渗透压307）和用生理盐水进行血液稀释（血细胞比容24.7，渗透压307）期间测量顺应性和心室功能（心室内球囊）。与NH相比，成年组在血液稀释90分钟后顺应性或功能无变化。与NH相比，幼犬组血液稀释后顺应性显著降低（P<0.001），当将收缩压峰值与舒张末期容积作图时，心室功能无变化。电子显微镜照片证实，血液稀释时幼犬组比成年组有更多的水肿形成。这些变化表明，在血液稀释期间，新生儿心脏比成年心脏对水肿形成更敏感，并且当顺应性降低时，灌注后早期的充盈压不一定反映心室功能。
