膜式氧合器及动脉滤器祛泡功能探析.docVIP

膜式氧合器及动脉滤器祛泡功能探析 　【摘要】 目的评价Affinity 、Edwards和 Terumo三种膜式氧合器祛泡能力，并探讨使用膜式氧合器时动脉滤器使用的必要性。方法使用18例心脏手术后体外循环装置,分别为Affinity、Edwards和Terumo SX18三种成人膜式氧合器各6例，并均使用Terumo动脉滤器，在同等的检测条件下用注射器在膜式氧合器前的管路中注入30 ml空气，使用CMD-20超声波微气栓检测仪检测空气通过膜式氧合器后及动脉滤器后产生的微气栓数量。结果在膜式氧合器及动脉滤器后血流中测得微气栓平均数量分别为： Affinity（155.9±15.2）个和（69.869.8±6.7）个;Edwards（336.0±14.7）个和（135.3±6.1）个;Terumo（114.6±12.1）个和（52.8±5.5）个。结论不同的膜式氧合器有不同的祛泡能力；使用动脉滤器可显著降低体外循环产生微气栓的风险。 【关键词】 膜式氧合器;动脉滤器;体外循环;微气栓 　　Evaluation of the Ability of Membrane Oxygenator and the Arterial Filter to Remove the Gaseous Microemboli 　　Abstract: OBJECTIVE To investigate the ability to remove the gaseous microemboli of three kinds of membrane oxygenator,and the necessity to use arterial filter for membrane oxygenator.METHODSTo choose 18 extracorporeal circulation circuits after open heart surgery. Three kinds of membrane oxygenator (Affinity,Edwards and Terumo,n=6) and arterial filter were estimated for removing of gaseous microemboli.Counts of gaseous microemboli after membrane oxygenator and after arterial filter were tested in each group with Micro Bubble Counter (CMD-20 Terumo)under the same condition. RESULTSCounts of gaseous microemboli after different membrane oxygenator and after arterial filter were as following: (155.9 ±15.2) and (69.8±6.7) for Affinity, (336.0±14.7) and (135.3±6.1) for Edwards,(114.6±12.1) and (52.8±5.5) for Terumo . CONCLUSIONThe ability to remove gaseous microemboli is different for different membrane oxygenators. Arterial filter is necessary for extracorporal cirulation with membrane oxygenator to furtherly reduce the risk of engendering gaseous. 　　Key words：Membrane oxygenator；Arterial filter；Extracorporeal circulation；Gaseous microembolus 　　微气栓是体外循环（extracorporeal circulation，ECC）对机体的重要损伤因素之一，这一问题还没有得到很好的解决［1］。使用鼓泡氧合器、过度的复温梯度、动脉端未用滤器、静脉血储血室内低血平面、药物注射到管路内等都是产生微气栓的因素［2-4］。膜式氧合器的中空纤维表面微孔已由早期规律、直通型微孔发展为新型安全的无规则缝隙样微孔。一般认为微气栓进入膜式氧合器后可通过膜式氧合器中空纤维的微孔排出,也可经泵后型膜式氧合器排至静脉血储血室或滞留在氧合器内。由于膜式氧合器气血不直接接触，并具备不同程度的气泡捕捉和祛除能力，有些学者认为使用膜式氧合器