Department of Pediatric Cardiac Surgery, Rajaei Cardiovascular Medical and Research Center, Tehran, Iran.
Department of Clinical Research Development Unit of Besat Hospital, Hamadan University of Medical Sciences Medical School, Hamadan, Iran.
Artif Organs. 2020 Mar;44(3):288-295. doi: 10.1111/aor.13559. Epub 2019 Sep 30.
Cardiopulmonary bypass (CPB) requirement in infants presents a unique challenge because of the large prime volume-to-blood volume ratio. Packed red blood cells (PRBCs) tend to deteriorate with long-term storage owing to their unphysiological composition and osmolality. Given that blood priming is inevitable in neonates, it is suggested that the metabolic load and osmolality are diminished before CPB initiation. We conducted the present study to test the hypothesis that the zero-balance ultrafiltration (Z-BUF) of the priming blood with 0.45% saline might be sufficient for modifying the metabolic load and osmolality and, thus, achieving a physiological state. Sixty infants with a weight below 10 kg undergoing CPB were randomly assigned either to a control group or to a Z-BUF group and the Z-BUF of the priming blood was performed in the latter group. Electrolytes and osmolality were measured in the priming blood. The bleeding volume, the blood transfusion rate, the length of mechanical ventilation, the length of stay in the intensive care unit (ICU), the body temperature, and renal biomarkers were compared between the 2 groups. The osmolality and the levels of potassium, sodium, glucose, chloride, and lactate in the priming blood were significantly decreased after Z-BUF (P < .01). The Z-BUF group showed significant reductions in postoperative blood loss; postoperative blood transfusion; time to extubation; the length of stay in the ICU; the levels of lactate, sodium, and blood urea nitrogen at 24 hours postoperatively and the body temperature at 18 hours postoperatively (P < .05). However, no statistically significant differences were found between the 2 groups regarding the body temperature and the levels of serum creatinine and blood urea nitrogen after admission to the ICU. The results of the present study demonstrated that the Z-BUF of the priming blood could be a useful strategy in infants undergoing CPB insofar as it significantly modified the composition of the priming blood and improved the clinical outcome among our patients.
体外循环（CPB）在婴儿中需要面临独特的挑战，因为其预充液体积与血容量之比很大。由于其非生理组成和渗透压，储存时间长的浓缩红细胞（PRBC）往往会恶化。鉴于新生儿的血液预充是不可避免的，因此建议在 CPB 开始前降低代谢负荷和渗透压。我们进行了本研究，以验证以下假设：用 0.45%生理盐水对预充液进行零平衡超滤（Z-BUF）可能足以改变代谢负荷和渗透压，从而实现生理状态。将 60 名体重低于 10kg 的接受 CPB 的婴儿随机分配到对照组或 Z-BUF 组，后者对预充液进行 Z-BUF。测量预充液中的电解质和渗透压。比较两组间的出血量、输血率、机械通气时间、重症监护病房（ICU）停留时间、体温和肾生物标志物。Z-BUF 后预充液的渗透压和钾、钠、葡萄糖、氯和乳酸水平显著降低（P<0.01）。Z-BUF 组术后出血量、术后输血、拔管时间、ICU 停留时间、术后 24 小时乳酸、钠和血尿素氮水平以及术后 18 小时体温均显著降低（P<0.05）。然而，两组在 ICU 入住后的体温以及血清肌酐和血尿素氮水平方面无统计学差异。本研究结果表明，CPB 中预充液的 Z-BUF 可能是一种有用的策略，因为它可以显著改变预充液的组成，并改善我们患者的临床结果。
