共查询到20条相似文献,搜索用时 11 毫秒
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Brian Harvey Kenneth G. Shann David Fitzgerald Brian Mejak Donald S. Likosky Luc Puis Robert A. Baker Robert C. Groom for the American Society of ExtraCorporeal Technology’s International Consortium for Evidence-Based Perfusion Pediatric Perfusion Committee 《The Journal of extra-corporeal technology》2012,44(4):186-193
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G. Erdoes A. Koster M. I. Meesters E. Ortmann D. Bolliger E. Baryshnikova A. Ahmed M. D. Lance H. B. Ravn M. Ranucci C. von Heymann S. Agarwal 《Anaesthesia》2019,74(12):1589-1600
To date, data regarding the efficacy and safety of administering fibrinogen concentrate in cardiac surgery are limited. Studies are limited by their low sample size and large heterogeneity with regard to the patient population, by the timing of fibrinogen concentrate administration, and by the definition of transfusion trigger and target levels. Assessment of fibrinogen activity using viscoelastic point-of-care testing shortly before or after weaning from cardiopulmonary bypass in patients and procedures with a high risk of bleeding appears to be a rational strategy. In contrast, the use of Clauss fibrinogen test for determination of plasma fibrinogen level can no longer be recommended without restrictions due to its long turnaround time, high inter-assay variability and interference with high heparin levels and fibrin degradation products. Administration of fibrinogen concentrate for maintaining physiological fibrinogen activity in the case of microvascular post-cardiopulmonary bypass bleeding appears to be indicated. The available evidence does not suggest aiming for supranormal levels, however. Use of cryoprecipitate as an alternative to fibrinogen concentrate might be considered to increase plasma fibrinogen levels. Although conclusive evidence is lacking, fibrinogen concentrate does not seem to increase adverse outcomes (i.e., thromboembolic events). Large prospective multi-centre studies are needed to better define the optimal perioperative monitoring tool, transfusion trigger and target levels for fibrinogen replacement in cardiac surgery. 相似文献
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Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery
Tomoyuki Katayanagi 《Annals of thoracic and cardiovascular surgery》2015,21(1):37-44
Background: Mediastinitis caused by methicillin-resistant Staphylococcus aureus (MRSA) is a serious complication after pediatric cardiac surgery. An outbreak of surgical site infections (SSIs) provided the motivation to implement SSI prevention measures in our institution.Methods: Subjects comprised 174 pediatric patients who underwent open-heart surgery after undergoing preoperative nasal culture screening. The incidence of SSIs and mediastinitis was compared between an early group, who underwent surgery before SSI measures (Group E, n = 73), and a recent group, who underwent surgery after these measures (Group R, n = 101), and factors contributing to the occurrence of mediastinitis were investigated.Results: The incidence of both SSIs and Mediastinitis has significantly decreased after SSI measures. With regard to factors that significantly affected mediastinitis, preoperative factors were “duration of preoperative hospitalization” and “preoperative MRSA colonization,” intraoperative factors were “Aristotle basic complexity score,” “operation time,” “cardiopulmonary bypass circuit volume” and “lowest rectal temperature.” And postoperative factor was “blood transfusion volume.” Patients whose preoperative nasal cultures were MRSA-positive suggested higher risk of MRSA mediastinitis.Conclusions: SSI prevention measures significantly reduced the occurrence of SSIs and mediastinitis. Preoperative MRSA colonization should be a serious risk factor for mediastinitis following pediatric cardiac surgeries. 相似文献
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目的探讨零平衡超滤(ZBUF)和改良超滤(MUF)联合应用于婴幼儿体外循环(CPB)手术中的管理特点及临床效果,以判定二者联合应用的可行性及其临床意义。方法20例复杂先天性心脏病患者,其中男12例,女8例;年龄12.6±7.5个月;体重8.5±3.3kg。选用Gambro FH22型血液超滤器,采用经典MUF途径,CPB期间行ZBUF,CPB结束后行MUF。观察患者血流动力学指标、血气分析、生化离子浓度、炎性介质和血浆胶体渗透压(COP)的变化,同时收集滤液测定白细胞介素8(IL-8)和肿瘤坏死因子α(TNF-α)的浓度。结果所有患者MUF结束时平均动脉压(MAP)明显升高(P=0.001);血液乳酸、TNF-α和IL-8在ZBUF前、后差异无统计学意义;COP在MUF结束明显升高,与ZBUF结束比较差异有统计学意义(P=0.002)。MUF滤液中TNF-α浓度高于ZBUF滤液(P=0.036)。结论ZBUF与MUF联合应用于婴幼儿CPB手术中有排除炎性因子、改善机体免疫应答的能力;MUF可快速减少体内水分、提高COP和红细胞压积,从而改善心肺功能。 相似文献
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Evaluation of dynamic parameters of thrombus formation measured on whole blood using rotational thromboelastometry in children undergoing cardiac surgery: a descriptive study 下载免费PDF全文
David Faraoni Christian Fenger‐Eriksen Stephanie Gillard Ariane Willems Jerrold H. Levy Philippe Van der Linden 《Paediatric anaesthesia》2015,25(6):573-579
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Effect of Ultrafiltration During Cardiopulmonary Bypass
for Pediatric Cardiac Surgery 总被引:1,自引:0,他引:1
Takashi Watanabe Yoshimasa Sakai Toshihiko Mayumi Tsuyoshi Shimomura Min-Ho Song Kazuyoshi Tajima Yoshito Suenaga Yoshitaka Kawaradani Yasutaka Saito & Teiji Yamada 《Artificial organs》1998,22(12):1052-1055
The effect of ultrafiltration during cardiopulmonary bypass (CPB) was evaluated for correcting ventricular septal defects with associated pulmonary hypertension in patients less than 18 months old. Interleukin (IL)-6 and IL-8 concentrations in the blood, ultrafiltrate, and urine were measured. The blood IL-6 concentration increased to 128.4 ± 20.2 pg/ml by the end of surgery, which is lower than the concentration seen in adult patients (273.1 ± 48.2 pg/ml, p < 0.02). The blood IL-8 concentration was not significantly different than that of adults. The total amounts of excreted IL-6 in the ultrafiltrate and urine during CPB were 11.5 ± 0.32 pg/kg and 0.32 ± 0.07 pg/kg, respectively (p < 0.05). The total amounts of excreted IL-8 in the ultrafiltrate and urine were 4.64 ± 0.69 pg/kg and 1.92 ± 0.56 pg/kg, respectively (p < 0.05). No differences were seen in these values for excretion between children and adults. We conclude that ultrafiltration during CPB in pediatric patients is more effective in removing proinflammatory cytokines than in adults and more effective than renal filtration alone. 相似文献
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Effects of Modified Ultrafiltration on Coagulation Factors in Pediatric Cardiac Surgery 总被引:8,自引:0,他引:8
Purpose. Modified ultrafiltration (MUF) after cardiopulmonary bypass (CPB) in children has been reported to reduce the need for postoperative
blood transfusion and minimize postoperative blood loss. This study was undertaken to quantify the effects of MUF on coagulation
factors in pediatric patients.
Methods. Seven children scheduled to undergo open-heart surgery for congenital heart defects were studied. CPB cir-cuits were primed
with crystalloid solutions and no blood transfusions were performed. Hematocrit, platelet count, total plasma proteins, albumin,
fibrinogen, prothrombin, factor VII, factor IX, and factor X were measured preoperatively, at the termination of cardiopulmonary
bypass, and at the end of modified ultrafiltration.
Results. MUF was associated with significant (P < 0.05) increases in hematocrit (17.6% ± 1.6% to 21.6% ± 2.4%), platelet count 11.1 ± 2.5 to 12.8 ± 2.4 × 104/mm3), total plasma proteins (2.7 ± 0.3 to 3.4 ± 0.4 g/dl), and albumin (1.6 ± 0.2 to 2.1 ± 0.2 g/dl). Fibrinogen, prothrombin,
and factor VII also increased significantly (P < 0.05) during MUF, but factor IX and factor X did not change.
Conclusion. We conclude that MUF attenuates the dilutional coagulopathy that occurs during CPB in children. There were slight improvements
in the coagulation factors when MUF was employed.
Received: October 5, 2000 / Accepted: September 11, 2001 相似文献
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Excessive bleeding following pediatric cardiopulmonary bypass is associated with increased morbidity and mortality, both from the effects of hemorrhage and the therapies employed to achieve hemostasis. Neonates and infants are especially at risk because their coagulation systems are immature, surgeries are often complex, and cardiopulmonary bypass technologies are inappropriately matched to patient size and physiology. Consequently, these young children receive substantial amounts of adult‐derived blood products to restore adequate hemostasis. Adult and pediatric data demonstrate associations between blood product transfusions and adverse patient outcomes. Thus, efforts to limit bleeding after pediatric cardiopulmonary bypass and minimize allogeneic blood product exposure are warranted. The off‐label use of factor concentrates, such as fibrinogen concentrate, recombinant activated factor VII, and prothrombin complex concentrates, is increasing as these hemostatic agents appear to offer several advantages over conventional blood products. However, recognizing that these agents have the potential for both benefit and harm, well‐designed studies are needed to enhance our knowledge and to determine the optimal use of these agents. In this review, our primary objective was to examine the evidence regarding the use of factor concentrates to treat bleeding after pediatric CPB and identify where further research is required. PubMed, MEDLINE/OVID, The Cochrane Library and the Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched to identify existing studies. 相似文献
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Fumio Fukumura Akira Sese Yasutaka Ueno Yutaka Imoto Masato Sakamoto Yoshihisa Tanoue Hiromichi Sonoda 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2003,51(11):577-581
Objective: We evaluated changes of the haemostatic system during pediatric cardiac surgery during and after cardiopulmonary bypass
(CPB).Method: Twenty-five children under 15 kg of body weight under-going open-heart surgery were divided into three groups; 9 patients
(Group A), no bank blood was used throughout the surgery; 8 patients (Group B), packed red cells were used in the priming
of CPB circuit; 8 patients (Group C) in cyanotic condition, for whom surgery was performed without bank blood. CPB caused
a significant decrease of platelet counts in all three groups, the levels of which remained similar next morning.Results: Platelet counts decreased more significantly in Group C (59±27 k/mm3) than in Group A (119±42 k/mm3) and B (104±27 k/mm3). Platelet function-platelet activating factor test (HemoSTATUSTM) did not significantly decrease throughout the perioperative period in Group A. Hemo-STATUSTM value decreased during CPB and recovered after CPB in Group B and C. Prothrombin time international ratio (PT-INR) and activated
partial thromboplastin time were significantly prolonged just after CPB and recovered until next morning in all three groups.
PT-INR was more prolonged in Group C (2.92±0.62) than in Group A (2.08±0.27) and B (2.42±0.42). There was no significant difference
in postoperative bleeding for the first 12 hours among the three groups.Conclusion: Although extreme hemodilution during CPB significantly impairs the coagulation and platelet system, these changes are usually
transient and tolerable with minimal postoperative hemorrhage. However, a prolonged CPB and preoperative cyanotic condition
may induce a critical decrease of platelet counts and increase postoperative bleeding. 相似文献
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