Liu Y, Tao L, Wang X, Cui H, Chen X, Ji B
Department of Cardiopulmonary Bypass, Wuhan Asia Heart Hospital, Wuhan 430022, Peoples R China.
Perfusion. 2012 Jan;27(1):83-9. doi: 10.1177/0267659111424636. Epub 2011 Oct 10.
In this study, we assessed clinical results by using a minimal extracorporeal circuit (MECC) and compared it to a conventional cardiopulmonary bypass (CPB) system in patients undergoing coronary artery bypass grafting (CABG) procedures.
From August to October 2006, forty consecutive patients undergoing isolated CABG procedures were randomly assigned to either a miniaturized closed circuit CPB with the Maquet-Cardiopulmonary MECC system (Group M, n=20) or to a conventional CPB system (Group C, n=20). Clinical outcomes were observed before, during and after the operation. Besides evaluating the perioperative clinical data, serial blood venous samples were obtained after induction, 30 minutes after CPB initiation, 2h, 6h, 12h, and 24h post-CPB. The focus of our study was on myocardial damage (cTnI), neutrophil and platelet counts, activated partial thromboplastin time (aPTT) and free hemoglobin.
Both the transfusion of packed red blood cells and fresh frozen plasma were significantly lower in Group M compared to Group C (p<0.05). The levels of cTnI were lower in Group M at 2h, 6h and 12h post-CPB than in Group C (p<0.01). The values of aPTT in Group M recovered to normal levels after surgery, but were prolonged in Group C at early post-CPB and were statistically longer than Group M at 2h, 6h, and 12h post-CPB (p<0.05). The concentrations of free hemoglobin in Group C were higher than in Group M during and post-CPB, and there was a statistical difference at 2h post-CPB (p<0.05).
In conclusion, the MECC system is a safe alternative for patients who undertake extracorporeal circulation (ECC) for CABG surgery. Lower transfusion requirements and less damage to red cells may further promote the use of MECC systems, especially in higher risk patients.
在本研究中，我们评估了使用最小体外循环（MECC）的临床结果，并将其与接受冠状动脉旁路移植术（CABG）的患者的传统心肺转流（CPB）系统进行比较。
2006年8月至10月，连续40例接受孤立CABG手术的患者被随机分配至使用Maquet - 心肺MECC系统的小型闭合回路CPB组（M组，n = 20）或传统CPB系统组（C组，n = 20）。在手术前、手术期间和手术后观察临床结果。除了评估围手术期临床数据外，在诱导后、CPB开始后30分钟、CPB后2小时、6小时、12小时和24小时采集系列静脉血样本。我们研究的重点是心肌损伤（肌钙蛋白I）、中性粒细胞和血小板计数、活化部分凝血活酶时间（aPTT）和游离血红蛋白。
与C组相比，M组的浓缩红细胞和新鲜冰冻血浆输注量显著更低（p < 0.05）。CPB后2小时、6小时和12小时，M组的肌钙蛋白I水平低于C组（p < 0.01）。M组的aPTT值在术后恢复至正常水平，但C组在CPB早期延长，且在CPB后2小时、6小时和１2小时在统计学上长于M组（p < 0.05）。C组的游离血红蛋白浓度在CPB期间和CPB后高于M组，且在CPB后2小时存在统计学差异（p < 0.05）。
总之，MECC系统对于接受CABG手术进行体外循环（ECC）的患者是一种安全的替代方案。更低的输血需求和对红细胞的更少损伤可能会进一步促进MECC系统的使用，尤其是在高风险患者中。
