Gholampour Dehaki Maziar, Niknam Sana, Azarfarin Rasoul, Bakhshandeh Hooman, Mahdavi Mohammad
Rajaie Cardiovascular, Medical & Research Center-Perfusion, Tehran Province, Tehran, Iran.
Artif Organs. 2019 Feb;43(2):167-172. doi: 10.1111/aor.13325. Epub 2018 Oct 5.
Blood priming is needed for cardiopulmonary bypass (CPB) in neonates and infants to avoid exceeding hemodilution; however, transfusion-related inflammation affects post-CPB outcomes in infant open-heart surgery. Procalcitonin, a newly detected inflammatory moderator and a sensitive parameter for predicting pulmonary dysfunction secondary to CPB, rises after CPB. We hypothesized that the hemofiltration of priming blood before CPB might decrease inflammatory mediators in the blood and post-CPB inflammatory replications, thereby improving the respiratory function after CPB in infants. Sixty infants with a weight below 10 kg were divided randomly into two equal groups of CPB with the zero-balance ultrafiltration (Z-BUF) of priming blood and CPB without it. The procalcitonin level was measured before anesthesia, after admission to the intensive care unit (ICU), and 24 h afterward. The respiratory index and pulmonary compliance were measured after anesthesia, at the end of CPB, and 2 h after admission to the ICU. Additionally, time to extubation was recorded. The Z-BUF of priming blood maintained electrolytes within a physiologic level, and procalcitonin had a slighter rise in the Z-BUF Group at 24 h after admission to the ICU (P = 0.05). The respiratory index was decreased in the Z-BUF Group, but the difference with the control group did not reach statistical significance (P > 0.05). The change in pulmonary compliance was significantly increased in the cyanotic patients in the intervention group, but there was no significant difference between the two groups. The time to extubation and the ICU stay were shorter in the Z-BUF Group (P < 0.05). A positive correlation was found between the peak procalcitonin concentration and the time to extubation directly and pulmonary compliance reversely. These results suggest that the Z-BUF of priming blood may have some beneficial clinical effects such as improved respiratory function and attenuated procalcitonin.
新生儿和婴儿的体外循环（CPB）需要进行血液预充以避免过度血液稀释；然而，输血相关炎症会影响婴儿心脏直视手术的CPB术后结局。降钙素原是一种新发现的炎症调节因子，也是预测CPB继发肺功能障碍的敏感参数，在CPB后会升高。我们假设在CPB前对预充血液进行血液滤过可能会减少血液中的炎症介质和CPB后的炎症反应，从而改善婴儿CPB后的呼吸功能。将60名体重低于10kg的婴儿随机分为两组，一组在CPB时对预充血液进行零平衡超滤（Z-BUF），另一组不进行。在麻醉前、入住重症监护病房（ICU）后及之后24小时测量降钙素原水平。在麻醉后、CPB结束时及入住ICU后2小时测量呼吸指数和肺顺应性。此外，记录拔管时间。预充血液的Z-BUF使电解质维持在生理水平，入住ICU后24小时，Z-BUF组的降钙素原升高幅度较小（P = 0.05）。Z-BUF组的呼吸指数降低，但与对照组的差异未达到统计学意义（P>0.05）。干预组中青紫型患者的肺顺应性变化显著增加，但两组之间无显著差异。Z-BUF组的拔管时间和ICU住院时间较短（P<0.05）。降钙素原峰值浓度与拔管时间呈正相关，与肺顺应性呈负相关。这些结果表明，预充血液的Z-BUF可能具有一些有益的临床效果，如改善呼吸功能和减轻降钙素原升高。
