临床评估五种膜式氧合器在不同温度下跨膜压差.docVIP

临床评估五种膜式氧合器在不同温度下跨膜压差 　 作者：刘瑞芳，邢家林，缪娜，柳薇，吉冰洋 【摘要】 目的 评估五种中空纤维膜式氧合器( HFMO) 在体外循环(CPB)中不同温度下的跨膜压差 (TMPD)。方法 40例择期CPB下行心脏直视手术患者依据使用HFMO的不同随机分为五组(每组8例)：A组(Affinty)，C组(Cobe)，J组 (Jostra)，P组(Polystan)和T组(Terumo)。在CPB全流量后(T1)、 最低温度时(T2)、复温后 (T3)监测灌注流量、鼻咽温度、红细胞比积、平均动脉压，并在HFMO的入口和出口处监测压力的变化。结果 各组术前的临床参数没有显著性差异(Pgt;0.05)。TMPD在不同的时点J组为最小，其他依次分别为A组0.05)。A组、P组和T组在低温过程中的TMPD分别高于T1和T3，但没有显著性差异(Pgt;0.05)。结论 J组和A组的TMPD较低可能更有利于减少对血细胞的破坏，更适合应用于CPB时间较长的心脏手术。 【关键词】 膜式氧合器;跨膜压差;体外循环;温度 　　Abstract: OBJECTIVE To evaluate five type commercial available oxygenators of the trans-membrane pressure drop (TMPD) during normothermic and hypothermic cardiopulmonary bypass (CPB). METHODS Forty patients scheduled for cardiac surgery participated this study and were divided into five groups (n=8,in per-group) according to type of oxygenators used during CPB: group J (Joatra Quardox), group A (Affinity NT), group P (Polystan Safe Maxi), group T (Terumo Capiox SX) and group C (COBE APEX-TM). Parameters were collected during CPB including mean arterial pressure, pump flow, temperature, hematocrit and TMPD at pre- and post-oxygenator during normothermic(T1), hypothermic,28 ℃ (T2) and after rewarming (T3). RESULTS There was no significant difference among five groups in pre-operative clinical parameters (Pgt;0.05). TMPDs of group J were the lowest in different time-points, followed by the other group were group A lt; group P lt; group T lt; group C. TMPD of group J and A compared to the other three groups were lower (Plt;0.01) respectively and J was significant lower than group A at T2 (Plt;0.01). Except TMPDs of group P were significantly lower than group C (Plt;0.01) at T1, there were no statistical significance (Pgt; 0.05) in various time-points. Although TMPDs in group A, P and T during T2 were higher than T1 and T3, but there were no statistical significance (Pgt;0.05) in various time-points.CONCLUSION The TMPD of HFMOs in group J and A produced significantly lower and during normothermic and hypotherm