高流量改良超滤对室间隔缺损患儿手术期间脑氧合及灌注的影响：一项初步研究。
Influence of high-flow modified ultrafiltration on brain oxygenation and perfusion during surgery for children with ventricular septal defects: a pilot study.
作者信息
Jia Zaishen, Teng Yichao, Liu Yuan, Wang Hong, Li Yue, Hou Xiaotong
机构信息
1 Department of Extracorporeal Circulation, Centre for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China.
2 Department of Biomedical Engineering, Medical School, Tsinghua University, Beijing, China.
出版信息
Perfusion. 2018 Apr;33(3):203-208. doi: 10.1177/0267659117736120. Epub 2017 Oct 6.
BACKGROUND
Modified ultrafiltration (MUF) can be performed in infants with ventricular septal defects (VSDs) after cardiopulmonary bypass (CPB) to reduce haemodilution and its potential adverse effects. High-flow MUF might reduce ultrafiltration duration and hasten the necessary correction of haemodilution during CPB. However, its influence on brain oxygenation remains controversial.
OBJECTIVE
This non-randomized, prospective, pilot study aimed to investigate the influence of high-flow MUF on brain oxygenation in infants with VSDs.
METHODS
High-flow MUF (≥20 mL/kg/min) was performed in twenty infants. Brain oxygen saturation (rSO) and tissue haemoglobin index (tHI) were non-invasively and continuously measured intraoperatively using near-infrared spectroscopy (NIRS). Transcranial Doppler non-invasively detected the mean flow velocity of the middle cerebral artery (Vmean).
RESULTS
rSO increased significantly during MUF, as did tHI, Vmean, mean arterial pressure and haematocrit (all p<0.05). No correlation was found between changes in rSO and changes in other parameters (all p≥0.05).
CONCLUSION
In infants with ventricular septal defects managed with CPB during VSDs repair, high-flow MUF did not reduce brain oxygenation.
背景
改良超滤（MUF）可在室间隔缺损（VSD）患儿体外循环（CPB）后进行，以减少血液稀释及其潜在的不良影响。高流量MUF可能会缩短超滤时间，并加速CPB期间血液稀释的必要纠正。然而，其对脑氧合的影响仍存在争议。
目的
本非随机、前瞻性、试点研究旨在探讨高流量MUF对VSD患儿脑氧合的影响。
方法
对20例婴儿进行高流量MUF（≥20 mL/kg/min）。术中使用近红外光谱（NIRS）无创连续测量脑氧饱和度（rSO）和组织血红蛋白指数（tHI）。经颅多普勒无创检测大脑中动脉平均血流速度（Vmean）。
结果
MUF期间rSO显著升高，tHI、Vmean、平均动脉压和血细胞比容也显著升高（均p<0.05）。rSO变化与其他参数变化之间未发现相关性（均p≥0.05）。
结论
在室间隔缺损修补术中接受CPB治疗的室间隔缺损婴儿中，高流量MUF不会降低脑氧合。
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