Hemodilutional anemia impairs neurologic outcome after cardiopulmonary bypass in a piglet model
Hemodilutional anemia impairs neurologic outcome after cardiopulmonary bypass in a piglet model
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DOI：
10.1016/j.jtcvs.2006.08.048
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发表时间：
2007-01-01
影响因子：
6
通讯作者：
Kurosawa, Hiromi
中科院分区：
文献类型：
--
作者：
Miura, Takashi;Sakamoto, Takahiko;Kurosawa, Hiromi
目的：血液稀释对体外循环术后神经功能的影响尚不清楚。我们研究了红细胞压积对脑氧合和神经病理学结果的影响，在猪model.Methods：11头小猪（9.3 +/- 1.1公斤）被随机分为2组。5头仔猪（H组）接受全血预充，导致红细胞压积较高（33.0% +/- 2.3%），6头仔猪（L组）接受晶体预充，导致红细胞压积较低（14.0% +/- 3.2%）。两组均接受了90分钟的中度低温体外循环（28 ℃）和alpha-stat策略。通过近红外光谱监测脑氧合。L组在体外循环后立即输血，以达到术后目标红细胞压积30%。从体外循环脱机后6小时，大脑被固定在原位，神经损伤的组织学评分进行了assessed.Results：在整个实验组之间的动脉血气分析没有显着差异。在低温期间，H组的平均动脉压、混合静脉血氧饱和度和心率显著高于L组。近红外光谱检测的氧合血红蛋白和总血红蛋白信号在L组中显著较低（方差分析，P < .0001），尽管组织氧合指数在体外循环期间没有差异。与H组相比，L组的组织学评分较差（P < .0071）。结论：过度血液稀释，如红细胞压积低于15%，可能与神经损伤的高发生率相关。需要进一步的研究来确定小儿体外循环期间红细胞压积的安全限值。
Objectives: The effect of hemodilution on neurologic outcome after cardiopulmonary bypass remains unclear. We studied the influences of hematocrit on cerebral oxygenation and neuropathologic outcome in a piglet model.Methods: Eleven piglets (9.3 +/- 1.1 kg) were randomized into 2 groups. Five piglets (group H) received a total blood prime resulting in a high hematocrit (33.0% +/- 2.3%), and 6 piglets (group L) received a crystalloid prime resulting in a low hematocrit (14.0% +/- 3.2%). Both groups underwent 90 minutes of moderate hypothermic cardiopulmonary bypass (28 degrees C) with alpha-stat strategy. Cerebral oxygenation was monitored by near-infrared spectroscopy. Group L received a blood transfusion immediately after cardiopulmonary bypass to reach the postoperative target hematocrit of 30%. The brain was fixed in situ 6 hours after weaning from cardiopulmonary bypass, and a histologic score for neurologic injury was assessed.Results: There were no significant differences in arterial blood gas analyses throughout the experiment between the groups. Mean arterial pressure, mixed venous oxygen saturation, and heart rate were significantly higher in group H compared with group L during hypothermia. Oxyhemoglobin and total hemoglobin signals detected by near-infrared spectroscopy were significantly lower in group L (analysis of variance, P < .0001), although the tissue oxygenation index was not different during cardiopulmonary bypass. Group L showed a poorer histologic score compared with group H (P < .0071).Conclusions: Excessive hemodilution, such as a hematocrit of less than 15%, may be associated with a high incidence of neurologic injury. Further studies are required to determine the safety limits of hematocrit during pediatric cardiopulmonary bypass.