Perfusion technique for nonhaemic cardiopulmonary bypass prime in neonates and infants under 6 kg body weight
Perfusion technique for nonhaemic cardiopulmonary bypass prime in neonates and infants under 6 kg body weight
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新生儿和体重6公斤以下婴儿非血性心肺转流灌注技术
DOI：
10.1191/0267659104pf744oa
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
R. Hetzer
中科院分区：
文献类型：
--
作者：
F. Merkle;W. Boettcher;F. Schulz;A. Koster;M. Huebler;R. Hetzer
背景资料：新生儿和婴儿的心脏搭桥（CPB）与CPB回路预充时的显著血液稀释相关，而无需输注同源血液成分。当CPB回路小型化时，血液稀释的程度以及因此对输血的要求可以降低，而不影响患者安全。方法：在2002年1月至2003年10月期间，选择新生儿和小婴儿使用非血液预充体外循环进行手术。CPB预充量可通过使用带有桅杆安装滚子泵头的专用新生儿CPB控制台从300 mL减少到190 mL。预充量的减少是由于将所有CPB管路缩短至最低限度、缩小所有CPB管路尺寸、排除未使用的CPB组件、使用真空辅助静脉引流以及灌注师、心脏外科医生和麻醉师之间的密切合作。在不取消作为安全装置的动脉管路过滤器的情况下实现了预充体积的减少。结果如下：共9名体重在3.2 - 5.9 kg（平均4.7 kg）之间、体表面积为0.22 - 0.35 m2（平均0.29 m2）的患者使用改良的新生儿CPB回路和非血液预充进行手术。转流时间从38到167分钟不等（平均96分钟）。CPB时的平均红细胞压积为22.5%，范围为17 - 29%。所有患者的术后病程均顺利。结论：CPB预充量的显著减少使接受先天性心脏病复杂修复的新生儿和小婴儿的非血液预充CPB成为可能。
Background: Cardiopulmonary bypass (CPB) in neonates and infants is associated with significant haemodilution when priming of the CPB circuit is accomplished without transfusion of homologous blood components. The degree of haemodilution and, thus, the requirements for blood transfusion may be reduced when the CPB circuit is miniaturized without compromising patient safety. Method: Between January 2002 and October 2003, selected neonates and small infants were operated on using a nonhaemic prime extracorporeal circuit. CPB priming volume could be reduced from 300 mL to 190 mL by using a dedicated neonatal CPB console with mast-mounted roller pump heads. Reduction of priming volume resulted from shortening of all CPB lines to the minimum, downsizing of all CPB lines, exclusion of unused CPB components, use of vacuum-assisted venous drainage and from close co-operation between the perfusionist, cardiac surgeon and anaesthesiologist. The reduction in priming volume was achieved without eliminating the arterial line filter as safety device. Results: A total of nine patients weighing between 3.2 and 5.9 kg (mean 4.7 kg) and with a body surface area of 0.22 - 0.35m2 (mean 0.29m2) were operated on with the use of the modified neonatal CPB circuit and a nonhaemic prime. Bypass time varied from 38 to 167 min (mean 96 min). The mean haematocrit on CPB was 22.5% with a range of 17 - 29%. The postoperative course of all patients was uneventful. Conclusion: A significant reduction in CPB priming volume makes nonhaemic prime CPB in neonates and small infants undergoing complex repair of congenital heart defects possible.