Jia Zaishen, Teng Yichao, Liu Yuan, Wang Hong, Li Yue, Hou Xiaotong
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.
Perfusion. 2018 Apr;33(3):203-208. doi: 10.1177/0267659117736120. Epub 2017 Oct 6.
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.
This non-randomized, prospective, pilot study aimed to investigate the influence of high-flow MUF on brain oxygenation in infants with VSDs.
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).
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).
In infants with ventricular septal defects managed with CPB during VSDs repair, high-flow MUF did not reduce brain oxygenation.
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。
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。
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）。
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）。
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。
