Rodriguez Rosendo A, Watson Maura I, Nathan Howard J, Rubens Fraser
Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
J Extra Corpor Technol. 2006 Sep;38(3):216-9.
The objective of this study was to determine if surface-modifying additive (SMA) cardiopulmonary bypass (CPB) circuits are associated with a lower rate of cerebral microemboli during CPB compared with standard circuits. In a 2 x 2 factorial design, patients undergoing coronary artery bypass graft surgery were randomized to SMA or standard CPB circuits (with and without methyl-prednisolone). Transcranial Doppler was used to detect high-intensity transient signals (HITS) in both middle cerebral arteries. HITS were counted from onset to end of CPB. Intervals of interest were as follows: period 1, from CPB onset to aortic cross-clamping; period 2, from aortic cross-clamping to immediately before de-clamping; period 3, from aortic declamping to before aortic side-clamping; period 4, from the application of the aortic side clamp to immediately before the release of the side clamp; period 5, from aortic side clamp release to the end of CPB. There were 14 patients in each circuit group. No significant differences were found on the partial and total counts of HITS (medians [25th, 75th percentile]) between patients exposed to standard (total count: 228 HITS [174, 2801) and SMA circuits (total count: 156 HITS [104, 356]; p = .427). The median of the sum of HITS per patient associated with perfusionist interventions was not different between both circuit groups (standard: 17 HITS [7, 80]; SMA: 43 HITS [13, 168]; p = .085). This study, with a sample size of 28 patients, indicates that it is unlikely to find any difference in the count of HITS during CPB that is greater than 117 HITS between the two CPB circuits. Moreover, our findings emphasize the relevance of minimizing additional sources of cerebral microembolization during CPB that are not directly related to the biocompatible nature of the SMA CPB circuit.
本研究的目的是确定与标准体外循环（CPB）回路相比，表面改性添加剂（SMA）CPB回路在CPB期间是否与较低的脑微栓子发生率相关。在一项2×2析因设计中，接受冠状动脉旁路移植手术的患者被随机分配至SMA或标准CPB回路（使用和不使用甲基强的松龙）。采用经颅多普勒检测双侧大脑中动脉的高强度瞬态信号（HITS）。从CPB开始到结束对HITS进行计数。感兴趣的时间段如下：时间段1，从CPB开始到主动脉交叉阻断；时间段2，从主动脉交叉阻断到即将松开阻断钳之前；时间段3，从主动脉松开阻断钳到主动脉侧钳夹之前；时间段4，从应用主动脉侧钳到即将松开侧钳之前；时间段5，从主动脉侧钳松开到CPB结束。每个回路组有14例患者。在暴露于标准回路（总数：228次HITS [174, 280]）和SMA回路（总数：156次HITS [104, 356]；p = 0.427）的患者之间，HITS的部分计数和总计数（中位数[第25、75百分位数]）未发现显著差异。两个回路组中与灌注师干预相关的每位患者HITS总和的中位数无差异（标准回路：17次HITS [7, 80]；SMA回路：43次HITS [13, 168]；p = 0.085）。这项样本量为28例患者的研究表明，不太可能在两个CPB回路之间发现CPB期间HITS计数的差异大于117次HITS。此外，我们的研究结果强调了在CPB期间尽量减少与SMA CPB回路生物相容性无关的额外脑微栓塞来源的相关性。
