Rider Alan R, Schreiner Robert S, Undar Akif
Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Children's Hospital, Hershey, Pennsylvania 17033-0850, USA.
ASAIO J. 2007 Nov-Dec;53(6):706-9. doi: 10.1097/MAT.0b013e318158e3f9.
Multiple factors influence the outcome of cardiopulmonary bypass (CPB) procedures in pediatric patients with congenital heart defects. The benefit of pulsatile over nonpulsatile perfusion is one such factor that continues to be widely debated among researchers, perfusionists, and surgeons. However, by accurately measuring pulsatile flow in terms of energy equivalent pressure and surplus hemodynamic energy, pulsatile perfusion is clearly seen to replicate the physiologic heart in a manner unparalleled by nonpulsatile perfusion. Studied benefits of pulsatile perfusion in pediatric patients include increased vital organ blood flow and improvement in postoperative recovery. Also, the components of the extracorporeal circuit used in CPB are directly related to pulsatility and have a profound effect on hemodynamics in the circuit and the patient. Therefore, pulsatility and surplus hemodynamic energy delivery to the patient can be maximized by choosing the best performing heart-pumps, oxygenators, arterial filters, and cannulae. Furthermore, in using the most optimal circuit components available, the CPB procedure under pulsatile perfusion can proceed efficiently. Currently, the outcomes resulting from pulsatile perfusion in pediatric and adult patients, as well as animal models, are well documented. However, more multilaboratory efforts are necessary to understand and further validate the benefits of pulsatile perfusion in pediatric patients.
多种因素影响患有先天性心脏缺陷的儿科患者体外循环（CPB）手术的结果。搏动灌注相对于非搏动灌注的益处就是这样一个在研究人员、灌注师和外科医生中仍存在广泛争议的因素。然而，通过根据能量等效压力和剩余血流动力学能量准确测量搏动血流，可以清楚地看到搏动灌注以一种非搏动灌注无法比拟的方式复制了生理性心脏。在儿科患者中研究的搏动灌注益处包括增加重要器官血流量和改善术后恢复。此外，CPB中使用的体外循环组件与搏动性直接相关，并对循环和患者的血流动力学有深远影响。因此，通过选择性能最佳的心脏泵、氧合器、动脉滤器和插管，可以使输送给患者的搏动性和剩余血流动力学能量最大化。此外，在使用现有的最优化循环组件时，搏动灌注下的CPB手术可以高效进行。目前，儿科和成人患者以及动物模型中搏动灌注的结果已有充分记录。然而，需要更多的多实验室研究来理解并进一步验证搏动灌注对儿科患者的益处。
