Hodge Ashley, Cohen Apryl, Winch Peter, Tumin Dmitry, Burnside Jeffrey, Ratliff Todd, Galantowicz Mark, Naguib Aymen
The Heart Center at Nationwide Children's Hospital, Columbus, Ohio.
Department of Cardiovascular Perfusion, College of Health Professions, SUNY Upstate Medical University, Syracuse, New York; and.
J Extra Corpor Technol. 2017 Sep;49(3):168-173.
Hemodilution is one of the sequelae of cardiopulmonary bypass (CPB). Autologous blood priming (retrograde autologous priming [RAP]/venous antegrade priming [VAP]) and acute normovolemic hemodilution (ANH) may be effective techniques to minimize hemodilution. The primary objective of this study is to investigate the impact of RAP/VAP combined with ANH on changes in cerebral saturations. A retrospective analysis of 52 patients undergoing congenital cardiac surgery requiring CPB between July 2014 and March 2015 was performed. Bivariate analysis correlated RAP/VAP and ANH volumes. SO change scores were regressed on all covariates using multivariable least-squares models. The average percent of circulating blood volume (CBV) removed during RAP/VAP was 21 ± 10% in the cyanotic group and 15 ± 5% in the acyanotic group ( =.006). There was a decrease in SO from 70 ± 11% at baseline to 55 ± 13% at CPB initiation, although this decrease did not differ by cyanosis ( = .668) or use of ANH ( = .566). Bivariate correlation and multivariable regression analysis of the SO change score further demonstrated no statistically significant correlation between percent of CBV removed during RAP/VAP or ANH and the magnitude of the decline in SO RAP and VAP help minimize hemodilution at the onset of CPB. This study further supports the use of these techniques in a pediatric population by demonstrating declines in SO during RAP/VAP were consistent among cyanotic and acyanotic, including those who underwent ANH.
血液稀释是体外循环（CPB）的后遗症之一。自体血液预充（逆行自体预充[RAP]/静脉顺行预充[VAP]）和急性等容血液稀释（ANH）可能是将血液稀释降至最低的有效技术。本研究的主要目的是探讨RAP/VAP联合ANH对脑饱和度变化的影响。对2014年7月至2015年3月期间52例行先天性心脏手术需要CPB的患者进行回顾性分析。双变量分析将RAP/VAP和ANH容量进行关联。使用多变量最小二乘模型将SO变化分数对所有协变量进行回归分析。在发绀组中，RAP/VAP期间去除的循环血容量（CBV）平均百分比为21±10%，在非发绀组中为15±5%（P = 0.006）。SO从基线时的70±11%降至CPB开始时的55±13%，尽管这种下降在发绀情况（P = 0.668）或ANH使用情况（P = 0.566）方面没有差异。SO变化分数的双变量相关性和多变量回归分析进一步表明，RAP/VAP或ANH期间去除的CBV百分比与SO下降幅度之间无统计学显著相关性。RAP和VAP有助于在CPB开始时将血液稀释降至最低。本研究通过证明在RAP/VAP期间SO的下降在发绀和非发绀患者中是一致的，包括那些接受ANH的患者，进一步支持了这些技术在儿科人群中的应用。
