体外氧合回路的生物相容性对微创冠状动脉旁路移植术中溶血程度和氧状态优化的影响

V. Cherniy, L. O. Sobanska, Pavlo O. Topolov, Arina V. Grygorieva
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To improve the biocompatibility of the oxygenator, the circuit in Group 1 (Gr1) was treated with an adaptive composition, while in Group 2 (Gr2), the oxygenator circuit remained untreated. The following parameters were examined: hemoglobin (Hb), hematocrit (Ht), red blood cell count (RBC), oxygen delivery index (DO2I), oxygen consumption index (VO2I), oxygen extraction ratio (O2ER%), oxygen extraction index (O2EI%), venous (SpvO2), and arterial (SpaO2) oxygen saturation, oxygen tension in arterial (PaO2) and venous blood (PvO2), acid-base status of the blood (pH, pCO2,HCO3ˉ, BE), and the degree of hemolysis. \nResults. Before initiation of cardiopulmonary bypass (CPB), an insignificant increase in O2IE% was observed in Gr1 (26.07±1.57) and Gr2 (27.11±0.81); p=0.875, indicating an increase in tissue oxygen consumption. At the hypothermic stage CPB, both Gr1 and Gr2 demonstrated a statistically significant decrease in Hb, Ht, and RBC levels (p<0.05) due to hemodilution, accompanied by a decrease in IDO2, IVO2, O2IE%, and O2ER% in both groups due to hypothermia. After rewarming, O2ER% in Gr1 (22.91±2.68) and Gr2 (24.59±2.02); p=0.191, and O2EI% in Gr1 (22.92±2.44) and Gr2 (24.61±2.01); p=0.215, were in the normal range. After weaning off cardiopulmonary bypassin Gr2, O2EI% was 27.34±1.97, indicating an increase in oxygen consumption and oxygen extraction. Upon separation from CPB, Gr2 showed a tendency to mild compensated metabolic acidosis, mainly due to HCO3ˉ 21.9±0.3. During the rewarming stage, the hemolysis value was 0.36±0.09in Gr1 and 0.45±0.17 in Gr2 (p<0.001). After CPB, hemolysis was 0.41±0.15 in Gr1 and 0.61±0.22 in Gr2 (p<0.001). \nConclusions. 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引用次数: 0

摘要

导言。在微创冠状动脉旁路移植术(CABG)中,心肺旁路的一个显著特点是灌注时间明显较长,需要将血液从静脉主动引流至心脏切开储血器,这就存在发生溶血的风险。在这种情况下,机械溶血会破坏血液的气体运输功能。研究目的在微创冠状动脉旁路移植手术中减少溶血,优化患者的氧状态。材料和方法。研究纳入了 60 名患者,他们在中度低体温下接受了微创冠状动脉旁路移植术(CABG)和心肺旁路术(CPB)。患者被分为两组,每组 30 人。为了改善氧合器的生物相容性,第一组(Gr1)的电路采用了适应性成分,而第二组(Gr2)的氧合器电路则未作任何处理。对以下参数进行了检测血红蛋白 (Hb)、血细胞比容 (Ht)、红细胞计数 (RBC)、氧输送指数 (DO2I)、氧消耗指数 (VO2I)、氧萃取率 (O2ER%)、氧萃取指数 (O2EI%)、静脉血(SpvO2)和动脉血(SpaO2)氧饱和度、动脉血(PaO2)和静脉血(PvO2)氧张力、血液酸碱状态(pH、pCO2、HCO3ˉ、BE)以及溶血程度。结果在开始心肺旁路(CPB)前,观察到 Gr1(26.07±1.57)和 Gr2(27.11±0.81)的 O2IE% 显著增加;P=0.875,表明组织耗氧量增加。在低体温阶段 CPB,由于血液稀释,Gr1 和 Gr2 两组的 Hb、Ht 和 RBC 水平均有统计学意义的显著下降(p<0.05),同时由于低体温,两组的 IDO2、IVO2、O2IE% 和 O2ER% 均有下降。复温后,Gr1(22.91±2.68)和Gr2(24.59±2.02)的O2ER%(P=0.191)以及Gr1(22.92±2.44)和Gr2(24.61±2.01)的O2EI%(P=0.215)均处于正常范围。断开心肺旁路后,Gr2 的 O2EI% 为 27.34±1.97,表明耗氧量和析氧量增加。脱离 CPB 后,Gr2 出现轻度代偿性代谢性酸中毒倾向,主要原因是 HCO3ˉ 21.9±0.3。在复温阶段,Gr1 的溶血值为 0.36±0.09,Gr2 为 0.45±0.17(P<0.001)。CPB 后,Gr1 的溶血值为 0.41±0.15,Gr2 为 0.61±0.22(P<0.001)。结论在微创冠状动脉旁路移植术中,改善体外氧合回路的生物相容性可减少溶血,优化心肺旁路术后患者的氧状态。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
THE INFLUENCE OF BIOCOMPATIBILITY OF THE EXTRACORPOREAL OXYGENATOR CIRCUIT ON THE DEGREE OF HEMOLYSIS AND OPTIMIZATION OF OXYGEN STATUS IN MINIMALLY INVASIVE CORONARY ARTERY BYPASS GRAFTING
Introduction. A distinctive feature of cardiopulmonary bypass in minimally invasive coronary artery bypass grafting (CABG) is the significantly longer perfusion time, involving active blood drainage from the vein to the cardiotomy reservoir, which carries the risk of hemolysis development. In this context, mechanical hemolysis disrupts the gas transport function of the blood. The aim of the research. Reducing hemolysis and optimizing oxygen status of patients during minimally invasive coronary artery bypass grafting surgeries. Materials and methods. The study included 60 patients, who underwent minimally invasive coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) under moderate hypothermia. The patients were divided into two groups of 30 individuals each. To improve the biocompatibility of the oxygenator, the circuit in Group 1 (Gr1) was treated with an adaptive composition, while in Group 2 (Gr2), the oxygenator circuit remained untreated. The following parameters were examined: hemoglobin (Hb), hematocrit (Ht), red blood cell count (RBC), oxygen delivery index (DO2I), oxygen consumption index (VO2I), oxygen extraction ratio (O2ER%), oxygen extraction index (O2EI%), venous (SpvO2), and arterial (SpaO2) oxygen saturation, oxygen tension in arterial (PaO2) and venous blood (PvO2), acid-base status of the blood (pH, pCO2,HCO3ˉ, BE), and the degree of hemolysis. Results. Before initiation of cardiopulmonary bypass (CPB), an insignificant increase in O2IE% was observed in Gr1 (26.07±1.57) and Gr2 (27.11±0.81); p=0.875, indicating an increase in tissue oxygen consumption. At the hypothermic stage CPB, both Gr1 and Gr2 demonstrated a statistically significant decrease in Hb, Ht, and RBC levels (p<0.05) due to hemodilution, accompanied by a decrease in IDO2, IVO2, O2IE%, and O2ER% in both groups due to hypothermia. After rewarming, O2ER% in Gr1 (22.91±2.68) and Gr2 (24.59±2.02); p=0.191, and O2EI% in Gr1 (22.92±2.44) and Gr2 (24.61±2.01); p=0.215, were in the normal range. After weaning off cardiopulmonary bypassin Gr2, O2EI% was 27.34±1.97, indicating an increase in oxygen consumption and oxygen extraction. Upon separation from CPB, Gr2 showed a tendency to mild compensated metabolic acidosis, mainly due to HCO3ˉ 21.9±0.3. During the rewarming stage, the hemolysis value was 0.36±0.09in Gr1 and 0.45±0.17 in Gr2 (p<0.001). After CPB, hemolysis was 0.41±0.15 in Gr1 and 0.61±0.22 in Gr2 (p<0.001). Conclusions. Improving the biocompatibility of the extracorporeal oxygenatorcircuit makes it possible to reduce hemolysis and optimise the patient's oxygen status after cardiopulmonary bypass in minimally invasive coronary artery bypass grafting.
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