李春华
中国医学科学院阜外医院 麻醉科
One stage repair of interrupted aortic arch (IAA) associated with cardiac anomalies in neonates and infants is challenging for the entire surgical team. Deep hypothermic circulatory arrest (DHCA) prolongs myocardial and cerebral ischemia and may induce heart, brain, and major organ dysfunction. From May 2004 to May 2006, 13 infants with IAA underwent one stage repair by median sternotomy under DHCA with continuous regional cerebral perfusion (RCP) in Fuwai Children's Heart Center. Median age at operation was 10.4 +/- 6.7 months, and mean body weight was 6.58 +/- 2.15 kg. Temperature of nasopharynx was decreased to 18 degrees C-20 degrees C; rectal temperature was controlled at 19 degrees C-22 degrees C. Flow rate of RCP was maintained with 20-25 ml x kg x min under DHCA combined with RCP. Mean artery pressure (MAP) measuring from right radial artery was 32.5 +/- 5.8 mm Hg, and MAP from femoral artery was 11.2 +/- 3.5 mm Hg. Mean cardiopulmonary bypass (CPB) time was 141.6 +/- 21.7 min, and mean aortic clamp time was 52.3 +/- 10.9 min. Mean duration of RCP was 31.5 +/- 12.4 min. Mean intubation time in intensive care unit (ICU) was 54.7 +/- 12.6 hours, and mean ICU stay was 67.9 +/- 28.4 hours. This report describes our CPB protocol under DHCA using continuous RCP in low weight pediatric patients to minimize neurological complications during one stage IAA repair and summarizes the various CPB managements in recent literature as well.
ASAIO journal (American Society for Artificial Internal Organs : 1992) 2007
Studies have demonstrated that systemic inflammatory response syndrome (SIRS) remains one of the major causes of cardiopulmonary bypass (CPB)-associated organ injury during pediatric cardiac surgery. The purpose of this investigation was to compare the effectiveness of methylprednisolone (MP) and zero-balance ultrafiltration (ZBUF) on SIRS during pediatric CPB. Thirty infants undergoing open-heart surgeries were randomized to receive either MP in the priming solution (group M, n = 15) or ZBUF during CPB (group Z, n = 15). All the patients survived. Plasma levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-10 (IL-10) were measured before CPB (T1), 5 min after the start of CPB (T2), at the termination of CPB (T3), the fourth hour (T4), and the eighth hour (T5) postoperatively. The results showed that the plasma concentrations of TNF-alpha in the Z group were significantly less than those in the M group at T4 and T5 (P < 0.05), and the plasma concentrations of IL-6 were significantly less than those in the M group at T4 (P < 0.05); the plasma concentrations of IL-8 in the Z group were significantly less than those in the M group at T5 (P < 0.05). There was no difference between two groups on the plasma concentrations of IL-10. The duration of postoperative mechanical ventilation was (9.6 +/- 0.8 h) in the M group and (7.8 +/- 0.4 h) in the Z group (P < 0.05). This study showed that application of ZBUF is more effective to decrease the level of inflammatory mediators including TNF-alpha, IL-6, and IL-8 than administration of MP after pediatric CPB.
Artificial organs 2007
This study compared the effect of unprocessed and processed packed red blood cells (PRBCs) with the continuous autotransfusion system (CATS) during neonate heart surgery. Sixteen neonatal patients undergoing cardiac surgery were randomly divided into two groups: unprocessed PRBC (C group, n = 8); processed PRBC (P group, n = 8). The CATS was employed perioperatively. Series laboratory and clinical parameters, including levels of hematocrit, blood potassium, blood glucose, blood lactate, acid-base, and total priming volume of PRBC, were used to compare the effect between the two groups. Before CPB, the hematocrit of processed PRBCs in P group was significantly higher than those in C group (p < 0.01), and the concentrations of potassium, blood glucose, and lactate of processed PRBCs in P group were significantly lower than those in C group (p < 0.01). At the beginning and the end of CPB, the hematocrit levels in P group were all higher than those in C group (p < 0.05); lactate levels in P group were significantly lower than those in C group at the beginning of CPB (p < 0.01), and lower than that of C group at the end of CPB (p < 0.05). The total priming of PRBCs in P group was significantly less than that in C group (p < 0.01). Perioperative processing with CATS provided a high-quality RBC concentration, decreased the total priming of PRBCs, providing increased high-quality blood salvage during neonatal CPB procedure.
ASAIO journal (American Society for Artificial Internal Organs : 1992) 2007
OBJECTIVE:To study effects of pulmonary artery perfusion with hypothermic solution on the apoptosis of lung parenchymal cells during cardiopulmonary bypass.METHODS:Forty children with tetralogy of Fallot were divided into control group (n = 20) and protective group (n = 20). The patients in control group were performed using routine approaches. Patients' pulmonary artery were infused with 4 degrees C protective solution during cardiopulmonary bypass in protective group. Lung biopsy specimens were obtained after operations in order to study the apoptosis of lung parenchymal cells using tunnel techniques. At same time, patients' pulmonary functions and clinic index were monitored.RESULTS:The rate of apoptosis cells of lung parenchymal cells was (18 +/- 7)% in control group, whereas (10 +/- 2)% in protective group. There was significant difference between both groups (t = -2.95, P < 0.05). Index O(2) in protective group was higher than that in control group at 0, 6 and 12 hours after operations [(492 +/- 172), (444 +/- 104), (489 +/- 58) mm Hg versus (369 +/- 126), (347 +/- 107), (340 +/- 119) mm Hg, t = 2.59, P < 0.05; t = 2.88, P < 0.01; t = 5.06, P < 0.01, respectively)]. The time of mechanical ventilation was significantly shorter in protective group than in control group [(15 +/- 11) hours versus (26 +/- 15) hours, t = -2.76, P < 0.01].CONCLUSION:Pulmonary artery perfusion with hypothermic solution can inhibit the apoptosis of lung parenchymal cells and relieve cardiopulmonary bypass-induced lung injury.
Zhonghua wai ke za zhi [Chinese journal of surgery] 2004
OBJECTIVE:To study lung protection by perfusion with hypothermic protective solution to the pulmonary artery during total correction of tetralogy of Fallot (TOF).METHODS:Sixty-four consecutive children with TOF were randomly divided into control group (n = 30) and lung protective group (n = 34). The way of lung protection in the lung protective group was to perfuse with hypothermic protective solution to the pulmonary artery. Patients in the control group were subjected to routine approach. Patients' hemodynamics and lung functions were monitored. Plasma malondialdehyde (MDA), TNF-alpha and IL-6, IL-8 in tracheal suction were measured. Lung biopsy specimens were obtained after operations to study histological changes.RESULTS:The oxygen index was higher in the lung protect group than in the control group at 6 h, 12 h and 24 h after operation (t = 2.400, P < 0.05; t = 3.898, P < 0.01; t = 3.339, P < 0.01, respectively). The time for ICU and mechanical ventilation was significantly less in the lung protective group than in the control group (t = -2.652, P < 0.05; t = -2.081, P < 0.05). The level of MDA was lower in the lung protective group than in the control group at 0 h and 6 h after operations (t = -4.255, P < 0.01; t = -2.372, P < 0.05 respectively). The level of TNF-alpha was lower in the lung protective group than in the control group at 0 h, 6 h and 24 h after operation (t = 3.112, P < 0.01; t = 3.072, P < 0.01; t = 2.306, P < 0.05, respectively). The levels of IL-6, IL-8 in tracheal suction were lower in the lung protective group (t = -2.419, P < 0.05; t = -2.613, P < 0.01). Tissue examination showed intraalveolar edema, capillary hyperemia, leukocytes accumulated, and mitochondria swelling in the control group, whereas no change in the lung protective group.CONCLUSION:Perfusion with hypothermic protective solution to the pulmonary artery in CPB could reduce lung injury during the total correction of TOF.
Zhonghua wai ke za zhi [Chinese journal of surgery] 2002
OBJECTIVE:To compare the effects of conventional ultrafiltration and modified ultrafiltration in protecting patients' pulmonary function during cardiopulmonary bypass.METHODS:Thirty infants patients (less than 7 kg) were divided into two groups: conventional ultrafiltration group (CUF, n = 15) and modified ultrafiltration group (MUF, n = 15). The volume of ultrafiltration, transfusion, hematocrit (HCT) before and after ultrafiltration, patients' respiration function (respiration index, A-aDO2, airway pressure), the time of mechanical ventilation and ICU in the two groups were respectively monitored.RESULTS:The transfusion in MUF group was significantly less than in CUF group (P < 0.01), and the volume of ultrafiltration in MUF group was significantly more than in CUF group (P < 0.01). The time of mechanical ventilation and ICU staying in MUF group were significantly shorter in MUF group than that in CUF group (P < 0.05). At 12 and 24 hours after operations, the A-aDO2 in MUF group was lower than that in CUF group (P < 0.05), and the respiratory index in MUF group was higher than that in CUF group (P < 0.05).CONCLUSION:The modified ultrafiltration can effectively improve pulmonary function after operations for low weight infants.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 2002
