Ugaki Shinya, Ishino Kozo, Osaki Satoru, Kotani Yasuhiro, Honjo Osami, Hoshi Hideo, Yokoyama Naoyuki, Ohuchi Katsuhiro, Takatani Setsuo, Sano Shunji
Department of Cardiovascular Surgery, Okayama University, Okayama City, Japan.
ASAIO J. 2007 Nov-Dec;53(6):675-9. doi: 10.1097/MAT.0b013e3181590719.
We have developed a miniaturized semiclosed cardiopulmonary bypass (CPB) circuit incorporating a centrifugal blood pump (TinyPump) with a volume of 5 ml. The current study was undertaken to evaluate the hemolytic performance of the TinyPump in comparison with the BioPump and to investigate the impact of different CPB circuit volumes on hemodilution, coagulation, and the inflammatory response. Twelve 1-week-old piglets (3.4 +/- 0.2 kg) were used. The circuit comprised a centrifugal pump, a membrane oxygenator, and a cardiotomy reservoir. Cardiopulmonary bypass was conducted with mild hypothermia at 150 ml/kg/min for 3 hours. Transfusion was not performed. Priming volume was 68 ml for the circuit with the TinyPump and 111 ml for the circuit with the BioPump. Although the TinyPump required higher speed, plasma free hemoglobin levels after CPB were not different between the groups. After CPB, the TinyPump group had a significantly higher hematocrit (27% +/- 3% vs. 23% +/- 3%) and lower platelet reduction rate, lower thrombin-antithrombin complex levels, and lower interleukin-6 levels. Better lung compliance with less water content was observed in the TinyPump group. The TinyPump maintained CPB with acceptable hemolysis and lower inflammatory responses. This miniaturized CPB circuit may make transfusion-free open heart surgery feasible in neonates and would help to prevent postoperative organ dysfunction.
我们研发了一种小型化半封闭体外循环（CPB）回路，其包含一个容积为5毫升的离心血泵（TinyPump）。本研究旨在评估TinyPump与BioPump相比的溶血性能，并研究不同CPB回路容积对血液稀释、凝血及炎症反应的影响。使用了12只1周龄仔猪（3.4±0.2千克）。该回路包括一个离心泵、一个膜式氧合器和一个心内切开贮血器。在轻度低温下以150毫升/千克/分钟的流量进行体外循环3小时。未进行输血。使用TinyPump的回路预充量为68毫升，使用BioPump的回路预充量为111毫升。尽管TinyPump需要更高的转速，但两组体外循环后的血浆游离血红蛋白水平并无差异。体外循环后，TinyPump组的血细胞比容显著更高（27%±3%对23%±3%），血小板减少率更低，凝血酶 - 抗凝血酶复合物水平更低，白细胞介素 - 6水平更低。在TinyPump组中观察到肺顺应性更好且含水量更少。TinyPump在体外循环中维持了可接受的溶血水平及更低的炎症反应。这种小型化CPB回路可能使新生儿无输血心脏直视手术可行，并有助于预防术后器官功能障碍。
