Cardiovascular Surgery Clinic, Turkiye Yuksek Ihtisas Research and Training Hospital, Ankara, Turkey.
Cardiovascular Surgery Department, Hacettepe University, Ankara, Turkey.
Braz J Cardiovasc Surg. 2023 Feb 10;38(1):62-70. doi: 10.21470/1678-9741-2021-0519.
Extracorporeal perfusion flow type requires further investigation. The aim of this study is to compare the effects of pulsatile and nonpulsatile flow on oxygenator fibers that were analyzed by scanning electron microscope (SEM) and to extensively study patients' coagulation profiles, inflammatory markers, and functional blood tests.
Twelve patients who had open heart surgery were randomly divided into two groups; the nonpulsatile flow (group NP, six patients) and pulsatile flow (group P, six patients) groups. Both superficial view and axial sections of the oxygenator fiber samples were examined under SEM to compare the thickness of absorbed blood proteins and amount of blood cells on the surface of oxygenators. Platelet count, coagulation profile, and inflammatory predictors were also studied from the blood samples.
Fibrinogen levels after cardiopulmonary bypass were significantly lower in group NP (group P, 2.57±2.78 g/L; group NP; 2.39±0.70 g/L, P=0.03). Inflammatory biomarkers such as C-reactive protein, interleukin (IL)-6, IL-12, apelin, S100β, and tumor necrosis factor alpha were comparable in both groups. Axial sections of the oxygenator fiber samples had a mean thickness of 45.2 µm and 46.5 µm in groups P and NP, respectively, and this difference is statistically significant (P=0.006). Superficial view of the fiber samples showed obviously lower platelet, leukocyte, and erythrocyte levels in group P.
Our study demonstrated that both cellular elements and protein adsorption on oxygenator fibers are lower in the group P than in the group NP. Pulsatile perfusion has better biocompatibility on extracorporeal circulation when analyzed by SEM technique.
需要进一步研究体外灌注血流类型。本研究旨在通过扫描电子显微镜（SEM）比较搏动性和非搏动性血流对氧合器纤维的影响，并广泛研究患者的凝血谱、炎症标志物和功能血液测试。
12 名接受心脏直视手术的患者被随机分为两组；非搏动性血流组（NP 组，6 例）和搏动性血流组（P 组，6 例）。通过 SEM 检查氧合器纤维样本的表面视图和轴向截面，比较吸收血液蛋白的厚度和氧合器表面血细胞的数量。还从血液样本中研究了血小板计数、凝血谱和炎症预测因子。
体外循环后 NP 组的纤维蛋白原水平明显降低（P 组为 2.57±2.78 g/L；NP 组为 2.39±0.70 g/L，P=0.03）。两组的炎症生物标志物如 C 反应蛋白、白细胞介素（IL）-6、IL-12、apelin、S100β 和肿瘤坏死因子-α均相似。氧合器纤维样本的轴向截面在 P 组和 NP 组的平均值分别为 45.2 µm 和 46.5 µm，差异具有统计学意义（P=0.006）。纤维样本的表面视图显示 P 组的血小板、白细胞和红细胞水平明显较低。
我们的研究表明，与 NP 组相比，P 组的氧合器纤维上的细胞成分和蛋白质吸附都较低。通过 SEM 技术分析，搏动性灌注对体外循环具有更好的生物相容性。
