臨床評(píng)估五種膜式氧合器在不同溫度下的跨膜壓差

1、臨床評(píng)估五種膜式氧合器在不同溫度下的跨膜壓差         10-01-29 11:22:00     編輯：studa20                 作者：劉瑞芳，邢家林，繆娜，柳薇，吉冰洋【摘要】  目的 評(píng)估五種中空纖維膜式氧合器( HFMO) 在體外循環(huán)(CPB)中不同溫度下的跨膜壓差 (TM

2、PD)。方法 40例擇期CPB下行心臟直視手術(shù)患者依據(jù)使用HFMO的不同隨機(jī)分為五組(每組8例)：A組(Affinty)，C組(Cobe)，J組 (Jostra)，P組(Polystan)和T組(Terumo)。在CPB全流量后(T1)、 最低溫度時(shí)(T2)、復(fù)溫后 (T3)監(jiān)測(cè)灌注流量、鼻咽溫度、紅細(xì)胞比積、平均動(dòng)脈壓，并在HFMO的入口和出口處監(jiān)測(cè)壓力的變化。結(jié)果 各組術(shù)前的臨床參數(shù)沒(méi)有顯著性差異(P>0.05)。TMPD在不同的時(shí)點(diǎn)J組為最小，其他依次分別為A組0.05)。A組、P組和T組在低溫過(guò)程中的TMPD分別高于T1和T3，但沒(méi)有顯著性差異(P>0.05)。結(jié)論 J組和

3、A組的TMPD較低可能更有利于減少對(duì)血細(xì)胞的破壞，更適合應(yīng)用于CPB時(shí)間較長(zhǎng)的心臟手術(shù)。 【關(guān)鍵詞】  膜式氧合器;跨膜壓差;體外循環(huán);溫度Abstract: OBJECTIVE To evaluate five type commercial available oxygenators of the trans-membrane pressure drop (TMPD) during normothermic and hypothermic cardiopulmonary bypass (CPB). METHODS Forty patients scheduled for card

4、iac surgery participated this study and were divided into five groups (n=8,in per-group) according to type of oxygenators used during CPB: group J (Joatra Quardox), group A (Affinity NT), group P (Polystan Safe Maxi), group T (Terumo Capiox SX) and group C (COBE APEX-TM). Parameters were collected d

5、uring CPB including mean arterial pressure, pump flow, temperature, hematocrit and TMPD at pre- and post-oxygenator during normothermic(T1), hypothermic,28 (T2) and after rewarming (T3). RESULTS There was no significant difference among five groups in pre-operative clinical parameters (P>0.05). T

6、MPDs of group J were the lowest in different time-points, followed by the other group were group A < group P < group T < group C. TMPD of group J and A compared to the other three groups were lower (P<0.01) respectively and J was significant lower than group A at T2 (P<0.01). Except T

7、MPDs of group P were significantly lower than group C (P<0.01) at T1, there were no statistical significance (P> 0.05) in various time-points. Although TMPDs in group A, P and T during T2 were higher than T1 and T3, but there were no statistical significance (P>0.05) in various time-points.

8、CONCLUSION The TMPD of HFMOs in group J and A produced significantly lower and during normothermic and hypothermic CPB, thus blood trauma with these two HFMOs during CPB may be significantly lower compared to the other three.Key words： Membrane oxygenato; Pressure drop;Cardiopulmonary bypass; Hypert

9、hermia隨著生物醫(yī)學(xué)工程技術(shù)的進(jìn)步，中空纖維膜式氧合器(hollow-fiber membrane oxygenators,HFMO)的走血方式從纖維內(nèi)走血變?yōu)槔w維外走血，不僅減小了血流通過(guò)HFMO的阻力，同時(shí)減輕了由于高壓差帶來(lái)的高剪切應(yīng)力，從而減少了對(duì)血液細(xì)胞的破壞。本研究的目的是臨床觀察五種不同進(jìn)口HFMO在體外循環(huán)(cardiopulmonarybypass,CPB)中不同溫度下的跨膜壓差(Trans-membrane pressure drop,TMPD)。1 資料和方法1.1 病例選擇和分組 40例擇期CPB下行心臟直視手術(shù)患者依據(jù)使用HFMO的不同，隨機(jī)分為5組(每組8例)：

10、A組(Affinity NT, Medtronic)、C組(APEX-TM Sorin-COBE)、J組 (Quadrox Maquet-Jostra)、P組(Safe Maxi, Polystan A/S, Vaerlose)、T組(Capiox SX, Terumo Corp)。患者的一般情況見(jiàn)表1。5種HFMO功能參數(shù)見(jiàn)表2。1.2 麻醉和CPB 方法 患者均采用氣管內(nèi)插管靜吸復(fù)合麻醉下行開(kāi)心手術(shù)。體內(nèi)肝素3 mg/kg,應(yīng)用ACT儀(Hemochron Jr)監(jiān)測(cè)圍體外循環(huán)期的ACT，待ACT>400秒，動(dòng)靜脈插管建立CPB。使用Stockert-II或者Jostra-20 型人

11、工心肺機(jī), CPB 預(yù)充1 000 ml勃脈力、500 ml代血漿、10g白蛋白、1 mg/kg肝素; CPB 中的流量維持在2. 42. 8 L/ (min·m2 )，鼻咽溫維持在30左右。在阻斷心肌血流后采用高鉀冷血停搏液灌注心肌,每隔30 min灌注一次低鉀冷血停搏液。表1 患者術(shù)前和術(shù)中的臨床參數(shù)表2 五種HFMO的功能參數(shù)1.3 觀察指標(biāo)和測(cè)定方法 分別記錄五種HFMO的具體參數(shù)，見(jiàn)表2。分三個(gè)不同的溫度點(diǎn)T1(CPB并行全流量后)、 T2(最低鼻咽溫時(shí))、 T3(復(fù)溫后)，記錄灌注流量、最低鼻咽溫度、紅細(xì)胞比積(Hct)、平均動(dòng)脈壓(MAP)，并在HFMO的入口和出口處分別通過(guò)壓力傳感器監(jiān)測(cè)不同時(shí)點(diǎn)的壓力。1.4 統(tǒng)計(jì)學(xué)方法 采用SPSS軟件11.5統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì),首先應(yīng)用方差分析，如果組間存在顯著性差異,再應(yīng)用Student t-test比較任意兩組間的三個(gè)不同時(shí)點(diǎn)的TMPD。各組內(nèi)的三個(gè)不同時(shí)點(diǎn)TMPD的比較應(yīng)用配對(duì)t檢驗(yàn)，計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差( ±s )表示,以P<0.05為差異有顯著性意義，P<0.01為差異有極顯著意義。2 結(jié) 果2.1 各組間的患者一般情況和術(shù)中的主動(dòng)脈阻斷時(shí)間和CPB時(shí)間沒(méi)有顯著性差異(P>0