Undar Akif, Ji Bingyang, Lukic Branka, Zapanta Conrad M, Kunselman Allen R, Reibson John D, Khalapyan Tigran, Baer Larry, Weiss William J, Rosenberg Gerson, Myers John L
Department of Pediatrics, Penn State Milton S Hershey Medical Center, Hershey, PA 17033-0850, USA.
Perfusion. 2006 Nov;21(6):381-90. doi: 10.1177/0267659106073996.
The objectives of this investigation were (1) to compare two hollow-fiber membrane oxygenators (Capiox Baby RX versus Lilliput 1-D901) in terms of pressure drops and surplus hemodynamic energy (SHE) during normothermic and hypothermic cardiopulmonary bypass (CPB) in a simulated neonatal model; and (2) to evaluate pulsatile and non-pulsatile perfusion modes for each oxygenator in terms of SHE levels.
In a simulated patient, CPB was initiated at a constant pump flow rate of 500 mL/min. The circuit was primed with fresh bovine blood. After 5 min of normothermic CPB, the pseudo-patient was cooled down to 25 degrees C for 10 min followed by 30 min of hypothermic CPB. The pseudo-patient then underwent 10 min of rewarming and 5 min of normothermic CPB. At each experimental site (pre- and post-oxygenator and pre-aortic cannula), SHE was calculated using the following formula {SHE (ergs/cm3) = 1332 [((integralfpdt)/(integralfdt)) - mean arterial pressure]} (f = pump flow and p = pressure). A linear mixed-effects model that accounts for the correlation among repeated measurements was fit to the data to assess differences in SHE between oxygenators, pumps, and sites. Tukey's multiple comparison procedure was used to adjust p-values for post-hoc pairwise comparisons.
The pressure drops in the Capiox group compared to the Lilliput group were significantly lower during hypothermic non-pulsatile (21.3 +/- 0.5 versus 50.7 +/- 0.9 mmHg, p < 0.001) and pulsatile (22 +/- 0.0 versus 53.3 +/- 0.5 mmHg, p < 0.001) perfusion, respectively. Surplus hemodynamic energy levels were significantly higher in the pulsatile group compared to the non-pulsatile group, with Capiox (1655 +/- 92 versus 10008 +/- 1370 ergs/cm3, p < 0.001) or Lilliput (1506 +/- 112 versus 7531 +/- 483 ergs/cm3, p < 0.001) oxygenators. During normothermic CPB, both oxygenators had patterns similar to those observed under hypothermic conditions.
The Capiox oxygenator had a significantly lower pressure drop in both pulsatile and non-pulsatile perfusion modes. For each oxygenator, the SHE levels were significantly higher in the pulsatile mode.
本研究的目的是：（1）在模拟新生儿模型中，比较两种中空纤维膜式氧合器（Capiox Baby RX与Lilliput 1-D901）在常温及低温体外循环（CPB）期间的压力降和剩余血流动力学能量（SHE）；（2）根据SHE水平评估每种氧合器的搏动性和非搏动性灌注模式。
在模拟患者中，以500 mL/min的恒定泵流量启动CPB。回路用新鲜牛血预充。常温CPB 5分钟后，将模拟患者冷却至25℃并维持10分钟，随后进行30分钟的低温CPB。然后模拟患者进行10分钟的复温及5分钟的常温CPB。在每个实验部位（氧合器前后及主动脉插管前），使用以下公式计算SHE {SHE（尔格/cm³）= 1332 [（（积分fpdt）/（积分fdt））-平均动脉压]}（f =泵流量，p =压力）。采用考虑重复测量间相关性的线性混合效应模型对数据进行拟合，以评估氧合器、泵和部位之间SHE的差异。采用Tukey多重比较程序对事后两两比较的p值进行调整。
在低温非搏动性灌注（21.3±0.5对50.7±0.9 mmHg，p < 0.001）和搏动性灌注（22±0.0对53.3±0.5 mmHg，p < 0.001）期间，Capiox组的压力降与Lilliput组相比均显著更低。搏动组的剩余血流动力学能量水平显著高于非搏动组，使用Capiox氧合器（1655±92对10008±1370尔格/cm³，p < 0.001）或Lilliput氧合器（1506±112对7531±483尔格/cm³，p < 0.001）时均如此。在常温CPB期间，两种氧合器的模式与低温条件下观察到的模式相似。
Capiox氧合器在搏动性和非搏动性灌注模式下的压力降均显著更低。对于每种氧合器，搏动模式下的SHE水平均显著更高。
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