Kwak Jae Gun, Lee Jinkwon, Park Minkyoung, Seo Yu-Jin, Lee Chang-Ha
1 Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
2 Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi, Republic of Korea.
World J Pediatr Congenit Heart Surg. 2017 Mar;8(2):161-165. doi: 10.1177/2150135116681734.
This study examined the degree of hemolysis during vacuum-assisted venous drainage at different negative pressures to identify an adequate negative pressure that provides effective venous drainage without significant hemolysis in open-heart surgery in children weighing less than 10 kg.
Patients weighing less than 10 kg who underwent surgery for ventricular septal defect or atrial septal defect from 2011 to 2014 were enrolled. We used one of four negative pressures (20, 30, 40, or 60 mm Hg) for each patient. We measured haptoglobin, plasma hemoglobin, aspartate aminotransferase, and lactate dehydrogenase levels in the patients' blood three times perioperatively and determined the potential correlation between the change in each parameter with the level of negative pressure.
Forty-six patients were enrolled in this study (mean age: 7.1 ± 7.0 months, mean body weight: 6.1 ± 1.8 kg). There were no significant differences according to the degree of negative pressure with respect to patient age, body weight, cardiopulmonary bypass (CPB) time, aorta cross-clamping time, blood flow during CPB, or lowest body temperature. All parameters that we measured reflected progression of hemolysis during CPB; however, the degree of change in the parameters did not correlate with negative pressure.
In pediatric patients weighing less than 10 kg, the change in the degree of hemolysis did not differ with the amount of negative pressure. We may apply negative pressures up to 60 mm Hg without increasing the risk of hemolysis, with almost same the level of hemolysis using negative pressures of 20, 30, and 40 mm Hg for effective venous drainage and an ideal operative field during open-heart surgery.
本研究检测了不同负压下真空辅助静脉引流过程中的溶血程度，以确定在体重小于10kg的儿童心脏直视手术中，能提供有效静脉引流且无明显溶血的合适负压。
纳入2011年至2014年接受室间隔缺损或房间隔缺损手术的体重小于10kg的患者。对每位患者使用四种负压（20、30、40或60mmHg）之一。在围手术期对患者血液进行三次测量，检测触珠蛋白、血浆血红蛋白、天冬氨酸转氨酶和乳酸脱氢酶水平，并确定各参数变化与负压水平之间的潜在相关性。
本研究共纳入46例患者（平均年龄：7.1±7.0个月，平均体重：6.1±1.8kg）。在患者年龄、体重、体外循环（CPB）时间、主动脉阻断时间、CPB期间血流量或最低体温方面，根据负压程度无显著差异。我们测量的所有参数均反映了CPB期间溶血的进展；然而，参数的变化程度与负压无关。
在体重小于10kg的儿科患者中，溶血程度的变化与负压量无关。在心脏直视手术中，我们可以应用高达60mmHg的负压而不增加溶血风险，使用20、30和40mmHg负压时溶血水平几乎相同，以实现有效的静脉引流和理想的手术视野。
