Wernovsky G, Wypij D, Jonas R A, Mayer J E, Hanley F L, Hickey P R, Walsh A Z, Chang A C, Castañeda A R, Newburger J W, Wessel D L
Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
Circulation. 1995 Oct 15;92(8):2226-35. doi: 10.1161/01.cir.92.8.2226.
The neurological morbidity associated with prolonged periods of circulatory arrest has led some cardiac surgical teams to promote continuous low-flow cardiopulmonary bypass as an alternative strategy. The nonneurological postoperative effects of both techniques have been previously studied only in a limited fashion.
We compared the hemodynamic profile (cardiac index and systemic and pulmonary vascular resistances), intraoperative and postoperative fluid balance, and perioperative course after deep hypothermia and support consisting predominantly of total circulatory arrest or low-flow cardiopulmonary bypass in a randomized, single-center trial. Eligibility criteria included a diagnosis of transposition of the great arteries and a planned arterial switch operation before the age of 3 months. Of the 171 patients, 129 (66 assigned to circulatory arrest and 63 to low-flow bypass) had an intact ventricular septum and 42 (21 assigned to circulatory arrest and 21 to low-flow bypass) had an associated ventricular septal defect. There were 3 (1.8%) hospital deaths. Patients assigned to low-flow bypass had significantly greater weight gain and positive fluid balance compared with patients assigned to circulatory arrest. Despite the increased weight gain in the infants assigned to low-flow bypass, the duration of mechanical ventilation, stay in the intensive care unit, and hospital stay were similar in both groups. Hemodynamic measurements were made in 122 patients. During the first postoperative night, the cardiac index decreased (32.1 +/- 15.4%, mean +/- SD), while pulmonary and systemic vascular resistance increased. The measured cardiac index was < 2.0 L.min-1.m-2 in 23.8% of the patients, with the lowest measurement typically occurring 9 to 12 hours after surgery. Perfusion strategy assignment was not associated with postoperative hemodynamics or other nonneurological postoperative events.
After heart surgery in neonates and infants, both low-flow bypass and circulatory arrest perfusion strategies have comparable effects on the nonneurological postoperative course and hemodynamic profile.
与长时间循环骤停相关的神经并发症促使一些心脏外科团队推广持续低流量体外循环作为一种替代策略。此前仅以有限的方式对这两种技术的非神经术后影响进行过研究。
在一项随机、单中心试验中，我们比较了深低温及主要由全循环骤停或低流量体外循环支持后的血流动力学参数（心脏指数以及体循环和肺循环血管阻力）、术中和术后液体平衡以及围手术期过程。入选标准包括大动脉转位的诊断以及计划在3个月龄前进行动脉调转手术。171例患者中，129例（66例分配至循环骤停组，63例分配至低流量体外循环组）室间隔完整，42例（21例分配至循环骤停组，21例分配至低流量体外循环组）合并室间隔缺损。有3例（1.8%）住院死亡。与分配至循环骤停组的患者相比，分配至低流量体外循环组的患者体重增加明显更多且液体平衡为正。尽管分配至低流量体外循环组的婴儿体重增加更多，但两组的机械通气时间、重症监护病房停留时间和住院时间相似。对122例患者进行了血流动力学测量。术后第一个晚上，心脏指数下降（32.1±15.4%，平均值±标准差），而肺循环和体循环血管阻力增加。23.8%的患者测得的心脏指数<2.0 L·min-1·m-2，最低测量值通常出现在术后9至12小时。灌注策略分配与术后血流动力学或其他非神经术后事件无关。
在新生儿和婴儿心脏手术后，低流量体外循环和循环骤停灌注策略对非神经术后过程和血流动力学参数具有相似的影响。
