Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Training and Research Hospital, Istanbul, Turkey.
Eur J Cardiothorac Surg. 2012 Mar;41(3):581-6. doi: 10.1093/ejcts/ezr002. Epub 2011 Oct 18.
To compare neonates receiving arterial switch operation (ASO) either with mild or moderate hypothermic cardiopulmonary bypass.
Forty neonates undergoing ASO were randomized to receive either mild (Mi > 32 °C, n = 20) or moderate (Mo > 26 °C, n = 20) hypothermic cardiopulmonary bypass (CPB) between April 2007 and June 2010. All patients were diagnosed with simple transposition of the great arteries. Mean age (Mi: 8.32 ± 4.5 days, Mo: 7.54 ± 5.0 days, P = 0.21) and body weight were similar in both groups (Mi: 3.64 ± 0.91 kg, Mo: 3.73 ± 0.84 kg, P = 0.14). Follow-up was 3.1 ± 2.5 years for all patients.
Lowest perioperative rectal temperature was 33.5 ± 1.4 °C (Mi) versus 28.2 ± 2.1 °C (Mo) (P < 0.001). All patients safely weaned from CPB required lower doses of dopamine (Mi: 5.1 ± 2.4 µg/kg min, Mo: 6.5 ± 2.1 µ/kg min, P = 0.04), dobutamine (Mi: 7.2 ± 2.5 µg/kg min, Mo: 8.6 ± 2.4 µ/kg min, P = 0.04) and adrenalin (Mi: 0.02 ± 0.02 µg/kg min, Mo: 0.05 ± 0.03 µ/kg min, P = 0.03) in mild hypothermia group. Intraoperative blood transfusion (Mi: 190 ± 58 ml, Mo: 230 ± 24 ml, P = 0.03) and postoperative lactate levels (Mi: 2.7 ± 0.9 mmol/l, Mo: 3.1 ± 2.2 mmol/l, P = 0.02) were lower under mild hypothermia. Secondary chest closure was performed in 30% (Mi) versus 35% (Mo) (P = 0.65). Duration of inotropic support (Mi: 7 (4-11) days, Mo: 11 (7-15) days, P = 0.03), time to extubation (Mi: 108 (88-128) h, Mo: 128 (102-210) h, P = 0.04), lengths of intensive care unit (ICU) stay (Mi: 9 (5-14) days, Mo: 12 (10-18) days, P = 0.04) and hospital stay (Mi: 19 (10-29) days, Mo: 23 (15-37) days, P = 0.04) were significantly shorter under mild hypothermia. Two-year freedom from reoperation was 100% for both the groups.
The ASO under mild hypothermia seemed to be beneficial for pulmonary recovery, need for inotropic support and length of ICU and hospital stay. No worse early- or intermediate-term effects of mild hypothermia were found.
比较接受动脉调转手术（ASO）的新生儿在轻度或中度低温心肺转流下的情况。
2007 年 4 月至 2010 年 6 月，40 例接受 ASO 的新生儿被随机分为接受轻度（Mi > 32°C，n = 20）或中度（Mo > 26°C，n = 20）低温心肺转流（CPB）的两组。所有患者均被诊断为单纯大动脉转位。两组的平均年龄（Mi：8.32 ± 4.5 天，Mo：7.54 ± 5.0 天，P = 0.21）和体重相似（Mi：3.64 ± 0.91 kg，Mo：3.73 ± 0.84 kg，P = 0.14）。所有患者的随访时间为 3.1 ± 2.5 年。
最低围手术期直肠温度为 33.5 ± 1.4°C（Mi）与 28.2 ± 2.1°C（Mo）（P < 0.001）。所有患者均在 CPB 下安全撤离，需要较低剂量的多巴胺（Mi：5.1 ± 2.4 µg/kg min，Mo：6.5 ± 2.1 µ/kg min，P = 0.04）、多巴酚丁胺（Mi：7.2 ± 2.5 µg/kg min，Mo：8.6 ± 2.4 µ/kg min，P = 0.04）和肾上腺素（Mi：0.02 ± 0.02 µg/kg min，Mo：0.05 ± 0.03 µ/kg min，P = 0.03）。在轻度低温组中，术中输血（Mi：190 ± 58 ml，Mo：230 ± 24 ml，P = 0.03）和术后乳酸水平（Mi：2.7 ± 0.9 mmol/l，Mo：3.1 ± 2.2 mmol/l，P = 0.02）较低。二次开胸在 30%（Mi）与 35%（Mo）之间（P = 0.65）。儿茶酚胺支持时间（Mi：7（4-11）天，Mo：11（7-15）天，P = 0.03）、拔管时间（Mi：108（88-128）小时，Mo：128（102-210）小时，P = 0.04）、重症监护病房（ICU）住院时间（Mi：9（5-14）天，Mo：12（10-18）天，P = 0.04）和住院时间（Mi：19（10-29）天，Mo：23（15-37）天，P = 0.04）在轻度低温组中明显较短。两组患者术后 2 年的无再手术率均为 100%。
ASO 在轻度低温下似乎有利于肺功能恢复、儿茶酚胺支持需求以及 ICU 和住院时间。未发现轻度低温有更早或更中期的不良影响。
