改良股动、静脉插管体外循环中器官灌注效果的实验研究

目的比较改良股动、静脉插管体外循环(CPB)与常规CPB在相同流量灌注时对脑、肺、肝、肾、肠等重要器官灌注的效果。方法将20条犬(体重10～15kg)随机分为两组,每组10条。胸腔镜组:改良股动、静脉插管后建立CPB,经电视胸腔镜施行手术;常规开胸组:常规建立CPB手术。两组建立CPB后以相同的流量灌注,分别在无名动脉、左颈总动脉、肠系膜上动脉、肾动脉、对侧腘动脉、同侧腘动脉及其所有相伴行的静脉留置套管针,连接测压管道,于麻醉诱导后即刻(T1)、主动脉阻断前(T2)、主动脉阻断15min(T3)、主动脉开放15min(T4)、CPB结束后20min(T5)记录动、静脉压,并在以上时间点抽取相应部位静脉血测定静脉血氧饱和度(SvO2)。结果除了胸腔镜组同侧腘动脉灌注压明显低于常规开胸组(P<0.01)外,两组其余动脉的动脉灌注压比较差异均无统计学意义。主动脉阻断前、主动脉阻断15min、主动脉开放15min,胸腔镜组肾静脉、肠系膜上静脉、对侧腘静脉和同侧腘静脉的静脉压明显高于常规开胸组(P<0.05);胸腔镜组肾静脉、肠系膜上静脉、对侧腘静脉和同侧腘静脉SvO2低于常规开胸组(P<0.05)。结论改良股动、静脉插管与常规CPB相同流量灌注时其动脉灌注压相近,经股动、静脉插管下腔静脉平面以下的静脉压较常规开胸手术略高,因此,对小儿胸腔镜CPB的器官保护提供了理论依据。

Experimental Study of the Effect on Organic Perfusion in the Cardiopulmonary Bypass Through Femoral Artery-Vein Intubation with Improved Cannulas

Objective To compare the perfusion pressure between cardiopulmonary bypass (CPB) through improved intubations of femoral artery-vein and routine identical flow on organic perfusion such as brain,lung,liver,kidney,intestines,etc Methods Twenty dogs with body weight from 10-15kg were randomly divided into two groups: thoracoscope group(n=10): CPB was set up by the right femoral artery-vein for completely video assisted cardiac operations; routine thoracotomy group(n=10): CPB was set up by the aorta-caval vein.The perfusion pressure of innominate artery, left common carotid artery,superior mesenteric artery,renal artery,homonymic and opposite side popliteal artery and the pressure of concomitant vein were measured at the following time points:instantly after induction of anesthesia(T1),before aortic clamping(T2),fifteen minutes after aortic clamping(T3),fifteen minutes after aortic opening(T4),twenty minutes after stop(T5).The venous blood samples were collected at the preceding time points and venous oxygen saturation(SvO2) were measured. Results There were no significant difference between both groups in arterial perfusion pressure, besides perfusion pressure of homonymic popliteal artery in thoracoscope group was lower than that in routine thoracotomy group (P<0.01). Before aortic clamping,fifteen minutes after aortic clamping and fifteen minutes after aortic opening, venous pressure of renal vein, superior mesenteric vein,homonymic and opposite side popliteal vein in thoracoscope group were higher than those in routine thoracotomy group (P<0.05). SvO2 of renal vein,superior mesenteric vein, homonymic and opposite side popliteal vein in thoracoscope group were lower than those in routine thoracotomy group(P<0.05). Conclusion The improved femoral CPB has a similar perfusion pressure with routine CPB and a higher vein pressure than routine CPB below inferior vena cava after aortic intubations.So this experiment provides theoretical evidence for the organic protection of infants' thoracoscopic extracorporeal circulation.