Department of Cardiovascular Surgery, Istanbul Bilim University, Istanbul, Turkey.
Artif Organs. 2010 Nov;34(11):879-84. doi: 10.1111/j.1525-1594.2010.01159.x.
The objectives of this study were: (i) to evaluate the effects of perfusion modes (pulsatile vs. nonpulsatile) on vital organs recovery and (ii) to investigate the influences of two different perfusion modes on the homeostasis of thyroid hormones in pediatric patients undergoing cardiopulmonary bypass (CPB) procedures. Two hundred and eighty-nine consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease were prospectively entered into the study and were randomly assigned to two groups: the pulsatile perfusion group (Group P, n = 208) and the nonpulsatile perfusion group (Group NP, n = 81). All patients received identical surgical, perfusional, and postoperative care. Study parameters included total drainage, mean urine output in the intensive care unit (ICU), intubation time, duration of ICU and hospital stay, the need for inotropic support, pre- and postoperative enzyme levels (ALT [alanine aminotransaminase] and AST [aspartate aminotransaminase]), c-reactive protein, lactate, albumin, blood count (leukocytes, hematocrit, platelets), creatinine levels, and thyroid hormones (thyroid stimulating hormone [TSH], FT(3) [free triiodothyronine], FT(4) [free thyroxine]). All patients survived the perioperative and postoperative periods. There were no statistically significant differences in either preoperative or operative parameters between the two groups. Group P, compared to Group NP, required significantly less inotropic support, had a shorter intubation period, higher urine output in ICU, and shorter duration of ICU and hospital stay. Lower lactate levels and higher albumin levels were observed in Group P and there were no significant differences in creatinine, enzyme levels, blood counts, or drainage amounts between two groups. TSH, Total T(3) , Total T(4) , and FT(3) , FT(4) levels were markedly reduced versus their preoperative values in both groups. FT(3) and FT(4) levels were reduced significantly further in the nonpulsatile group both during CPB and at 72 h postoperation. The results of this study confirm our opinion that pulsatile perfusion leads to better vital organ recovery and clinical outcomes in the early postoperative period as compared to nonpulsatile perfusion in pediatric patients undergoing CPB cardiac surgery. The plasma concentrations of thyroid hormones are dramatically reduced during and after CPB, but pulsatile perfusion seems to have a protective effect of thyroid hormone homeostasis compared to nonpulsatile perfusion.
（i）评估灌注模式（搏动性与非搏动性）对重要器官恢复的影响；（ii）研究两种不同灌注模式对体外循环（CPB）小儿患者甲状腺激素内稳态的影响。289 例连续接受心脏直视手术治疗先天性心脏病的小儿患者前瞻性地纳入本研究，并随机分为两组：搏动性灌注组（P 组，n=208）和非搏动性灌注组（NP 组，n=81）。所有患者均接受相同的手术、灌注和术后护理。研究参数包括总引流、重症监护病房（ICU）平均尿量、插管时间、ICU 和住院时间、需要正性肌力支持、术前和术后酶水平（ALT [丙氨酸氨基转移酶]和 AST [天冬氨酸氨基转移酶]）、C 反应蛋白、乳酸、白蛋白、血细胞计数（白细胞、红细胞压积、血小板）、肌酐水平和甲状腺激素（促甲状腺激素[TSH]、FT(3)[游离三碘甲状腺原氨酸]、FT(4)[游离甲状腺素]）。所有患者均在围手术期和术后期间存活。两组患者术前或术中参数均无统计学差异。与 NP 组相比，P 组需要的正性肌力支持显著减少，插管时间较短，ICU 尿量较高，ICU 和住院时间较短。P 组乳酸水平较低，白蛋白水平较高，两组肌酐、酶水平、血细胞计数或引流量无显著差异。TSH、总 T(3)、总 T(4)和 FT(3)、FT(4)水平在两组患者中均较术前显著降低。非搏动性组在 CPB 期间和术后 72 小时，FT(3)和 FT(4)水平进一步显著降低。本研究结果证实了我们的观点，即在 CPB 心脏手术的小儿患者中，与非搏动性灌注相比，搏动性灌注可导致重要器官更早恢复，并获得更好的术后早期临床结果。在 CPB 期间和之后，甲状腺激素的血浆浓度显著降低，但与非搏动性灌注相比，搏动性灌注似乎对甲状腺激素内稳态具有保护作用。
