Kotani Yasuhiro, Honjo Osami, Nakakura Mahito, Ugaki Shinya, Kawabata Takuya, Kuroko Yosuke, Osaki Satoru, Yoshizumi Ko, Kasahara Shingo, Ishino Kozo, Sano Shunji
Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Japan.
ASAIO J. 2007 Nov-Dec;53(6):662-5. doi: 10.1097/MAT.0b013e318158ddf6.
This study was undertaken to determine the impact of miniaturization of a cardiopulmonary bypass (CPB) circuit on blood transfusion and hemodynamics in neonatal open-heart surgery. Neonates (n = 102) undergoing open-heart surgery between 2002 and 2006 were included and divided into three groups: group 1 (n = 28), Dideco 902 oxygenator + 5/16" line; group 2 (n = 29), Dideco 901 oxygenator + 1/4" line; group3 (n = 45), Dideco 901 oxygenator + 3/16" arterial + 1/4" venous line. Amount of priming volume, blood and bicarbonate sodium use during CPB, and hemodynamics were compared. Priming volume in the groups 2 and 3 was significantly less compared with the group 1 (group 1, 575 +/- 37 ml; group 2, 328 +/- 12 ml, group 3, 326 +/- 5 ml, p < 0.05). Blood transfusion and bicarbonate sodium use during CPB in groups 2 and 3 were significantly less compared with group 1. Hemodynamics during CPB was comparable. There were no differences between groups 2 and 3 in any parameter. Miniaturization of the CPB circuit resulted in decrease in priming volume and subsequent reduction in blood and bicarbonate sodium use. Downsizing the lines had minimal impact on any of the parameters studied, and further efforts should be made to achieve neonatal open-heart surgery without blood transfusion.
本研究旨在确定体外循环（CPB）回路小型化对新生儿心脏直视手术中输血及血流动力学的影响。纳入2002年至2006年间接受心脏直视手术的新生儿（n = 102），并将其分为三组：第1组（n = 28），Dideco 902氧合器 + 5/16英寸管道；第2组（n = 29），Dideco 901氧合器 + 1/4英寸管道；第3组（n = 45），Dideco 901氧合器 + 3/16英寸动脉管道 + 1/4英寸静脉管道。比较了预充量、CPB期间血液和碳酸氢钠的使用量以及血流动力学。第2组和第3组的预充量明显少于第1组（第1组，575 ± 37 ml；第2组，328 ± 12 ml，第3组，326 ± 5 ml，p < 0.05）。第2组和第3组CPB期间的输血和碳酸氢钠使用量明显少于第1组。CPB期间的血流动力学相当。第2组和第3组在任何参数上均无差异。CPB回路的小型化导致预充量减少，进而使血液和碳酸氢钠的使用量减少。缩小管道尺寸对所研究的任何参数影响最小，应进一步努力实现无输血的新生儿心脏直视手术。
