Potger Kieron C, McMillan Darryl, Ambrose Mark
Perfusion and Autotransfusion Unit, Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Sydney, Australia.
J Extra Corpor Technol. 2013 Jun;45(2):77-85.
An important mechanism for postoperative cognitive impairment after cardiac surgery using cardiopulmonary bypass (CPB) is microemboli. One component of the CPB circuit-the cardiotomy-is a major source of gaseous microemboli because it aspirates significant volumes of air with blood from the operative field and intracardiac chambers. Cardiotomies are either integrated within an open hardshell venous reservoir (IC-HSVR) or are a separate canister attached to a softshell collapsible venous reservoir bag (SC-SSVR). The purpose of this study was to compare the Medtronic IC-HSVR (Affinity NT CVR) with Medtronic's SC-SSVR (CB 1351, CBMVR 1600) in terms of relative microbubble transmission during cardiotomy infusion. A recirculating in vitro circuit primed with blood was used to compare the two cardiotomy-reservoir systems with the venous reservoir in the SC-SSVR further assessed in a fully closed or partially open state (SC-SSVR-closed; SC-SSVR-open). Microbubbles were detected using a GAMPT BC100 Doppler system in the outflow line of the venous reservoir. Measurements were taken before (baseline) and after aerated prime was pumped into the cardiotomy while altering pump flow rates (3 L/min; 5 L/min) and reservoir prime volumes (400 mL; 900 mL). Infusing cardiotomy blood into the venous reservoir was associated with an increase in microbubbles and bubble volume transmitted by both cardiotomy-reservoir systems with the magnitude rising with reduced prime volumes. The effect was markedly greater with the IC-HSVR. The IC-HSVR also transmitted larger bubbles, particularly with reduced prime volumes. There was no significant difference in microbubble transmission seen between the SC-SSVR-closed and SC-SSVR-open. The SC-SSVR transmits fewer microbubbles than the IC-HSVR during cardiotomy infusion and should be considered as the preferential system. Because both cardiotomy-reservoir systems transmitted microbubbles during cardiotomy infusion, particularly at the lower venous reservoir volume, it is important to use strategies to minimize cardiotomy microbubble infusion.
体外循环（CPB）心脏手术后发生术后认知功能障碍的一个重要机制是微栓子。CPB回路的一个组成部分——心内吸引器——是气态微栓子的主要来源，因为它会从手术区域和心腔内抽吸大量含有空气的血液。心内吸引器要么集成在开放式硬壳静脉储血器（IC-HSVR）中，要么是连接到软壳可折叠静脉储血袋（SC-SSVR）的单独罐。本研究的目的是比较美敦力IC-HSVR（Affinity NT CVR）和美敦力SC-SSVR（CB 1351、CBMVR 1600）在心内吸引器灌注期间的相对微泡传输情况。使用预充血液的体外循环回路来比较两种心内吸引器-储血器系统，并对SC-SSVR中的静脉储血器在完全封闭或部分开放状态下（SC-SSVR-封闭；SC-SSVR-开放）进行进一步评估。在静脉储血器的流出管路中使用GAMPT BC100多普勒系统检测微泡。在向心内吸引器泵入充气预充液之前（基线）和之后进行测量，同时改变泵流速（3 L/分钟；5 L/分钟）和储血器预充液量（400 mL；900 mL）。将心内吸引器血液输注到静脉储血器中会导致两种心内吸引器-储血器系统传输的微泡和泡体积增加，其幅度随着预充液量减少而上升。IC-HSVR的这种效应明显更大。IC-HSVR还传输更大的气泡，尤其是在预充液量减少时。SC-SSVR-封闭和SC-SSVR-开放之间在微泡传输方面没有显著差异。在心脏切开术输注期间，SC-SSVR传输的微泡比IC-HSVR少，应被视为首选系统。由于两种心内吸引器-储血器系统在心脏切开术输注期间都会传输微泡，尤其是在静脉储血器体积较低时，因此采用策略尽量减少心脏切开术微泡输注非常重要。
