搏动体外循环增加小儿脑氧供及改善组织微循环的临床研究

目的通过观察大脑局部脑氧饱和度（ScO2）及血浆中内皮素-1（ET-1）的改变,判定小儿体外循环（ECC）期间搏动灌注与非搏动灌注对脑氧供和组织微循环灌注的影响。方法 40例行一期根治手术的典型法洛四联症患儿随机分为搏动灌注组（PP组,n=20）和非搏动灌注组（NP组,n=20）。PP组患儿在心脏阻断期间用Jostra HL20型人工心肺机行改良滚压泵搏动灌注,NP组ECC全程均采用传统滚压泵平流灌注。每位患儿的ScO2从麻醉诱导后一直持续监测到返回ICU 6 h。采集不同时点的血液标本测定血浆内皮素-1（ET-1）浓度及血浆游离血红蛋白（PFH）水平,通过血流动力学的持续观察对比搏动ECC的效果。结果在PP组通过有创血压监测即可观察到有效的搏动灌注效果,PP组在心脏阻断期间的脉压差（ΔP）明显高于NP组（P〈0.01）。PP组ScO2在心脏停跳阶段高于NP组,且这种优势一直持续到患儿返回ICU 2 h。ET-1水平在ECC结束时PP组低于NP组（P〈0.01）,且持续到ICU 8 h。PFH浓度在心肌阻断开放时、ECC结束时及ICU 2 h PP组均高于NP组（P〈0.05）。结论大脑局部ScO2对ECC期间脑氧的变化非常敏感。搏动ECC可以通过提高脑氧供并改善组织微循环来实现其趋于正常生理的灌注特性,但是在紫绀型患儿中搏动灌注有增加血液破坏的风险。

Clinical study of pulsatile cardiopulmonary bypass on increasing cerebral oxygenation and ameliorating tissue microcirculation in pediatric heart surgery

OBJECTIVE To evaluate the effects of pulsatile perfusion(PP) and nonpulsatile perfusion(NP) on cerebral oxygen saturation(ScO2) and endothelin-1(ET-1) in pediatric Tetralogy of Fallot(TOF) patients underwent open heart surgery with cardiopulmonary bypass(CPB).METHODS 40 pediatric patients were randomly divided into pulsatile perfusion group(PP,n=20) and nonpulsatile perfusion group(NP,n=20).In the PP group,modified roller pump was used to perform pulsatile perfusion during cross-clamping period in CPB,while...