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小儿体外循环期间使用的膜式氧合器技术的发展

Evolution of membrane oxygenator technology for utilization during pediatric cardiopulmonary bypass.

作者信息

Melchior Richard W, Sutton Steven W, Harris William, Dalton Heidi J

机构信息

Department of Perfusion Services, The Children's Hospital of Philadelphia, Philadelphia, PA.

Cardiovascular Support Services, Inc., Dallas, TX.

出版信息

Pediatric Health Med Ther. 2016 Jun 28;7:45-56. doi: 10.2147/PHMT.S35070. eCollection 2016.

Abstract

The development of the membrane oxygenator for pediatric cardiopulmonary bypass has been an incorporation of ideology and technological advancements with contributions by many investigators throughout the past two centuries. With the pursuit of this technological achievement, the ability to care for mankind in the areas of cardiac surgery has been made possible. Heart disease can affect anyone within the general population, but one such segment that it can affect from inception includes children. Currently, congenital heart defects are the most common birth defects nationally and worldwide. A large meta-analysis study from 1930 to 2010 was conducted in review of published medical literature totaling 114 papers with a study population of 24,091,867 live births, and divulged a staggering incidence of congenital heart disease involving 164,396 subjects with diverse cardiac illnesses. The prevalence of these diseases increased from 0.6 per 1,000 live births from 1930-1934 to 9.1 per 1,000 live births after 1995. These data reveal an emphasis on a growing public health issue regarding congenital heart disease. This discovery displays a need for heightened awareness in the scientific and medical industrial community to accelerate investigative research on emerging cardiovascular devices in an effort to confront congenital anomalies. One such device that has evolved over the past several decades is the pediatric membrane oxygenator. The pediatric membrane oxygenator, in conjunction with the heart lung machine, assists in the repair of most congenital cardiac defects. Numerous children born with congenital heart disease with or without congestive heart failure have experienced improved clinical outcomes in quality of life, survival, and mortality as a result of the inclusion of this technology during their cardiac surgical procedure. The purpose of this review is to report a summary of the published medical and scientific literature related to development of the pediatric membrane oxygenator from its conceptual evolutionary stages to artificially supporting whole body perfusion in the modern pediatric cardiac surgical setting.

摘要

小儿体外循环膜式氧合器的发展是过去两个世纪众多研究者将理念与技术进步相结合的成果。随着这一技术成就的实现,心脏外科领域关爱人类的能力成为可能。心脏病可影响普通人群中的任何人,但从一开始就可能受其影响的一个群体是儿童。目前,先天性心脏缺陷是全国乃至全球最常见的出生缺陷。一项针对1930年至2010年发表的医学文献进行的大型荟萃分析研究,共纳入114篇论文,研究对象为24,091,867例活产婴儿,结果显示先天性心脏病的发病率惊人,涉及164,396名患有各种心脏疾病的受试者。这些疾病的患病率从1930 - 1934年每1000例活产中的0.6例增加到1995年后每1000例活产中的9.1例。这些数据凸显了先天性心脏病这一日益严重的公共卫生问题。这一发现表明,科学和医疗行业需要提高认识,以加速对新型心血管设备的研究,从而应对先天性异常。过去几十年中不断发展的一种设备就是小儿膜式氧合器。小儿膜式氧合器与心肺机配合使用,有助于修复大多数先天性心脏缺陷。许多患有先天性心脏病且伴有或不伴有充血性心力衰竭的儿童,由于在心脏手术过程中采用了这项技术,在生活质量、生存率和死亡率方面都取得了更好的临床效果。本综述的目的是报告已发表的医学和科学文献的摘要,内容涉及小儿膜式氧合器从概念演变阶段到在现代小儿心脏手术中人工支持全身灌注的发展历程。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7658/5683297/3657446fc44a/phmt-7-045Fig1.jpg

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