Pediatric Intensive Care Unit, Mater Children's Hospital, Brisbane, Australia.
J Thorac Cardiovasc Surg. 2011 Jul;142(1):174-80. doi: 10.1016/j.jtcvs.2011.01.059. Epub 2011 Mar 21.
Systemic cooling for cardiopulmonary bypass is widely used to attenuate the systemic inflammatory response syndrome and organ injury in children after open surgery. We compared the effects of moderate (24 °C) and mild (34 °C) hypothermia during bypass on markers of the systemic inflammatory response syndrome and organ injury, and on clinical outcome after corrective surgery for congenital heart disease.
Sixty-six children (mean age, 6.8 ± 5.7 months; mean weight, 6.2 ± 2.3 kg) were randomized to 24 °C or 34 °C bypass temperature during cardiac surgery. Perfusion strategies were otherwise strictly identical. Clinical data and blood samples were collected before bypass, 5 minutes after aortic crossclamp release, and 4, 24, and 48 hours after bypass. Patients were followed up until discharge from the hospital.
In the 54 children with outcome data, bypass temperature did not influence the duration of mechanical ventilation between the 24 °C group and the 34 °C group (median [interquartile range] 22 [13-40] hours vs 14 [8-40] hours, P = .14), intensive care unit stay (43 [24-49] hours vs 29 [23-47] hours, P = .79), blood loss (29 [20-38] mL/kg vs 23 [13-38] mL/kg, P = .36), or incidence of postoperative infection (9% vs 11%, P = 1.0). There was no evidence of an influence of bypass temperature on the markers of acute inflammation, innate immune response, organ injury, coagulation, or hemodynamics.
There is no evidence that the systemic inflammatory response syndrome and organ injury after pediatric open surgery are influenced by bypass temperature. The routine use of hypothermic bypass may not be warranted in the pediatric population.
体外循环全身降温被广泛应用于减轻儿童开胸手术后全身炎症反应综合征和器官损伤。我们比较了体外循环期间中度（24°C）和轻度（34°C）低温对全身炎症反应综合征和器官损伤标志物的影响，以及对先天性心脏病矫正手术后临床结果的影响。
66 名儿童（平均年龄 6.8±5.7 个月；平均体重 6.2±2.3kg）随机分为 24°C 或 34°C 体外循环温度组。否则，灌注策略完全相同。采集患者体外循环前、主动脉阻断解除后 5 分钟以及体外循环后 4、24 和 48 小时的临床数据和血样。患者随访至出院。
在 54 名有结局数据的患儿中，体外循环温度并未影响 24°C 组和 34°C 组之间的机械通气时间（中位数[四分位距]22[13-40]小时比 14[8-40]小时，P=0.14）、重症监护病房停留时间（43[24-49]小时比 29[23-47]小时，P=0.79）、失血量（29[20-38]mL/kg 比 23[13-38]mL/kg，P=0.36）或术后感染发生率（9%比 11%，P=1.0）。体外循环温度对急性炎症、固有免疫反应、器官损伤、凝血或血液动力学标志物没有影响的证据。
体外循环温度对儿童开胸手术后全身炎症反应综合征和器官损伤没有影响。在儿科人群中，常规使用低温体外循环可能没有必要。
