Poswal Pardeep, Mehta Yatin, Juneja Rajeev, Khanna Sangeeta, Meharwal Zile Singh, Trehan Naresh
Department of Anaesthesiology, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi, India.
Ann Card Anaesth. 2004 Jan;7(1):44-50.
The use of nonpulsatile flow during extracorporeal circulation remains popular despite theoretical advantages of pulsatile cardiopulmonary bypass (CPB). Pulsatile CPB is considered to be more physiological than nonpulsatile flow as the pulsatile energy ensures the patency of the vascular bed and mechanical motion of tissue fluid around the cell membrane, improves microcirculation and enhances diffusion. The purpose of this study was to compare the effect of pulsatile and nonpulsatile flow on the coagulation profile, liver and kidney function and also on the haemodynamics in patients undergoing coronary artery bypass grafting on CPB. One hundred patients between 35 and 65 years of age with normal left ventricular function were randomly divided into two equal groups: Pulsatile (P) and nonpulsatile (NP). Haematological parameters, clotting profile, renal parameters, hepatic function tests and haemodynamic variables were measured preoperatively and postoperatively at specific intervals. Surgical, anaesthetic and CPB regimen was standard in all cases. There was a decrease in platelet count during and after CPB in both groups. Coagulation profile and renal function parameters remained similar in both groups except that creatinine clearance was better in group P on the first postoperative day. Urine output was also better in group P. There was no change in liver function tests in both groups. The haemodynamic variables were comparable in both groups. The systemic vascular resistance was higher in group NP postoperatively and oxygen consumption was higher in group P post CPB. In conclusion we did not find any significant difference between pulsatile and nonpulsatile flow during CPB except the creatinine clearance and urine output were better in pulsatile group.
尽管体外循环期间使用非搏动性血流仍然很普遍，但搏动性体外循环（CPB）具有理论优势。搏动性CPB被认为比非搏动性血流更符合生理，因为搏动能量可确保血管床通畅以及细胞膜周围组织液的机械运动，改善微循环并增强扩散。本研究的目的是比较搏动性和非搏动性血流对接受CPB冠状动脉搭桥术患者的凝血指标、肝肾功能以及血流动力学的影响。100例年龄在35至65岁之间、左心室功能正常的患者被随机分为两组，每组50例：搏动性组（P组）和非搏动性组（NP组）。在术前及术后特定时间间隔测量血液学参数、凝血指标、肾脏参数、肝功能检查及血流动力学变量。所有病例的手术、麻醉和CPB方案均为标准方案。两组在CPB期间及之后血小板计数均下降。两组的凝血指标和肾功能参数相似，但术后第一天P组的肌酐清除率更好。P组的尿量也更多。两组的肝功能检查均无变化。两组的血流动力学变量相当。术后NP组的全身血管阻力较高，CPB后P组的氧耗较高。总之，我们发现CPB期间搏动性和非搏动性血流之间没有任何显著差异，只是搏动性组的肌酐清除率和尿量更好。
