Zhang Cheng, Meng Baoying, Wu Keye, Ding Yiqun
Department of Cardiac Surgery, Shenzhen Children's Hospital, Shenzhen, China.
Perfusion. 2019 Sep;34(6):460-466. doi: 10.1177/0267659118825395. Epub 2019 Feb 10.
The existing cardiopulmonary bypass tubing system has already been significantly improved in our hospital by reducing the priming volume; thus, we further employed a new cardiopulmonary bypass strategy in children based on a miniaturized cardiopulmonary bypass circuit. We aimed to compare the effectiveness of new and conventional strategies by analyzing the outcomes after congenital heart surgery.
We performed a database analysis of all patients undergoing congenital heart surgery with cardiopulmonary bypass at Shenzhen Children's Hospital from 1 May 2015 to 30 June 2017. Propensity score matching was used to adjust for significant covariates, and multivariable regression models and stratified analysis were used to assess the association of cardiopulmonary bypass strategy with outcomes.
Of 925 total patients, 55.35% were in the conventional strategy group and 44.65% were in the new strategy group. After propensity score matching, there were 610 patients in total, with 305 patients in each group. In the multivariable regression models, the cardiopulmonary bypass strategy was not significantly associated with successful early extubation (p > 0.05), reintubation (p > 0.05), or nasal continuous positive airway pressure (p > 0.05) rates. The new strategy group had fewer hospital stays (p = 0.04) and intensive care unit stays (p < 0.05) compared with patients who underwent conventional strategy. The difference remained statistically significant (p < 0.05) when The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category was <3.
The implementation of a new cardiopulmonary bypass strategy, with selective ultrafiltration based on a miniaturized cardiopulmonary bypass circuit system, was safe and effective for children who underwent congenital heart surgery in a Chinese hospital. The new cardiopulmonary bypass strategy was associated with fewer hospital and intensive care unit stays.
我院已通过减少预充量对现有的体外循环管路系统进行了显著改进；因此，我们基于小型化体外循环回路在儿童中进一步采用了一种新的体外循环策略。我们旨在通过分析先天性心脏病手术后的结果来比较新策略和传统策略的有效性。
我们对2015年5月1日至2017年6月30日在深圳儿童医院接受体外循环先天性心脏病手术的所有患者进行了数据库分析。采用倾向得分匹配来调整显著的协变量，并使用多变量回归模型和分层分析来评估体外循环策略与结果之间的关联。
在总共925例患者中，55.35%在传统策略组，44.65%在新策略组。倾向得分匹配后，共有610例患者，每组305例。在多变量回归模型中，体外循环策略与早期成功拔管率（p>0.05）、再次插管率（p>0.05）或经鼻持续气道正压通气率（p>0.05）无显著关联。与接受传统策略的患者相比，新策略组的住院时间（p=0.04）和重症监护病房停留时间更少（p<0.05）。当胸外科医师协会-欧洲心胸外科学会分类<3时，差异仍具有统计学意义（p<0.05）。
在中国一家医院，基于小型化体外循环回路系统进行选择性超滤的新体外循环策略的实施对接受先天性心脏病手术的儿童是安全有效的。新的体外循环策略与更少的住院时间和重症监护病房停留时间相关。
