The Series Studies On Clinical Effects Of Ultrafiltration With Different Bloodstream Direction During Open Heart Surgery With Cardiopulmonary Bypass In Infants

Hemodilution used for cardiopulmonary bypass(CPB) decreases serum albumin concentration and colloid osmotic pressure and increases the capillary effective filtration pressure,leading to the accumulation of plasma water in the interstitial space. During cardiopulmonary bypass(CPB),blood first contacts the foreign surface of the extracorporeal circuit,ischemia of organs and reperfusion injury lead to activate the blood,including polymorphonuelearleukocyte,platelet,coagulation,kinin,and complement systems.And inflammator radiators release,the systemic inflammatory response is initiated.The mediators are main materials which elicit inflammatory response and organ injury.The behavior of cytokine production,mainly including tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6) and interleukin-8(IL-8).If the activated inflammatory response were out of control,and did not treated effectively,the multiple organs failure will be the result.Ultrafiltration is an important technique for CPB.It is mainly used in filtrating water,concentrating blood,and eliminating inflamatory mediators of low and middle molecules also,In generally,methods of ultrafiltration include conventional ultrafiltration(CUF),balanced ultrafiltration(BUF)and modified ultrafiltration(MUF). Since1970's,conventional ultrafiltration has been suggested as a means of reducing fluid accumulation.But it has not been proved satisfactory in young patients because of a relatively lower volume in the venous reservoir.Because the ultrfiltration can remove some harmful medium-size inflammatory mediators and relieve inflammatory response,Thus balanced ultrafiltration was originated,which is used throughout CPB to remove harmful medium-size solutes.Crystalloid solution is needed to keep a safe volume in the reservoir.But it haven't the ability to concentrate blood.In 1991,a modified method was reported by Naik,with advantages of being less limited by the level of fluid in the venous reservoir and more suitable to young patients.But the ability to relieve inflammatory factors was limited.So,in resent years,balanced ultrafiltration united modified ultrafiltration was used to combine the advantages of balanced ultrafiltration and modified ultrafiltration.But the MUF circuit produces an increased diastolic runoff from the aorta that steals flow from the cerebral circulation. It may decrease cerebral blood flow velocities and transcranial mixed venous oxygen saturations.Other possible disadvantages of this system include:(1) the potential for air entrainment at the aortic cannulation site,(2) limitations of flow due to the aortic size,(3) significant arterial to venous shunts,and(4) difficulty in maintaining desired filling pressure,temperature,and blood oxygen saturation.We think that using a venous-arterial continuous ulrtrafiltration system may avoid these potential disadvantages,and combine the advantages of traditional ultrafiltration mentioned above.So,in this article,the clinical application of venous-arterial ulrtrafiltration system was studied compared with arterial-venous ulrtrafiltration system.To investigate the effect and mechanism of ultrafiltration with different bloodstream derection in attenuating the the main organ edema and injury, and promoting the recovery after operation.There is no similar article reporting. PART1 Contrast study in the clinical application of V-A MUF and A-V MUF after cardiopulmonary bypass in infantsObjective Comparatively study in the clinical application of venous-arterial modified ultrafiltration(V-A MUF) and arterial-venous modified ultrafiltration(A-V MUF) after cardiopulmonary bypass in infants.To evaluate their effects in concentrating blood,excluding harmful inflammatory mediators,shorting operation time,remaining the body temperature and dynamics target of bloodstream stable, preventing and relieving the main organ edema and injury that may follow open heart surgery with cardiopulmonary bypass(CPB).Methods Thirty infants with congenital heart diseases were randomly divided into two groups.In the control group,A-V MUF was used after cardiopulmonary bypass.In the treated group,V-A MUF technique was used after cardiopulmonary bypass.The ultrafiltration time, ultrafiltration speed,body temperature,dynamics target of bloodstream,the serum concentrations of albumin and hematocrit,the serum concentration of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6),static pulmonary compliance (Cstat),airway resistence(Raw),alveolar-arterial oxygen difference(AaDO₂) were measured.Results The ultrafiltration speed was increased,MUF time and operation time was shorted in the treated group compared with the control group,there were statistical difference between the two groups(P＜0.01);In the MUF period,the body temperature and arterial pressure were stable,there were statistical difference between the two groups(P＜0.05);At the 5 minutes,10 minutes after the termination of CPB,the hematocrit and serum albumin concentrations were increased in the treated group compared with the control group,there were statistical difference between the two groups(P＜0.05);At the 20 minutes after the termination of CPB,there were no statistical difference between the two groups(P＞0.05);After MUF,the serum concentration of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6) were all decreased in the two groups,but there were no statistical difference between the two groups(P＞0.05);After MUF,the static pulmonary compliance(Cstat)was increased,airway resistence(Raw) and alveolar-arterial oxygen difference(AaDO₂) were decreased in the treated group compared with the control group(P＜0.05).Conclusions Compare to the A-V MUF,the clinical application of V-A MUF can effectively short MUF time and operation time,concentrate blood,remain the body temperature and dynamics target of bloodstream stable,attenuate lung edema and injury.PART2 Contrast study on the influence of ultrafiltration with different bloodstream direction in ultrafiltration time,ultrafiltration speed,body temperature,dynamics target of bloodstream,blood protection,blood concentrating and inflammatory mediators excluding during open heart surgery with cardiopulmonary bypass in infantsObjective Comparatively study on the influence of ultrafiltration with different bloodstream direction in ultrafiltration time,ultra:filtration speed,body temperature, dynamics target of bloodstream,blood protection,blood concentrating and inflammatory mediators excluding during open heart surgery with cardiopulmonary bypass in infants.Methods Thirty patients with congenital heart diseases were randomly divided into two groups.In the control group,balanced ultrafiltration united modified ultrafiltration was used during CPB.In the treated group,venous-medal continuous ultrafiltration was used throughout CPB.The ultrafiltration time, ultrafiltration speed,body temperature,dynamics target of bloodstream,the serum concentration of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6),the serum concentrations of albumin and hematocrit,the plasma levels of D-dimer and free hemoglobin(FHb) were measured.Results The ultrafiltration speed was increased and the ultrafiltration time after CPB was significantly shorted in the treated group compared with the control group(P＜0.01);In the ultrafiltration period after CPB,the body temperature and arterial pressure were stable,there were statistical difference between the two groups(P＜0.05);After ultrafiltration,the serum concentrations of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6) were decreased in the treated group compared with the control group(P＜0.05);At the 5 minutes after after the termination of CPB,the hematocrit and serum albumin concentrations were significantly increased in the treated group compared with the control group(P＜0.01);At the termination of CPB and the 10 minutes after the termination of CPB,the hematocrit and serum albumin concentrations were increased in the treated group compared with the control group(P＜0.05);At the 20 minutes after the termination of CPB,there were no statistical difference between the two groups(P＞0.05);The serum concentrations of free hemoglobin(FHb) in the treated group was lower than that of the control group,there were statistical difference between the two groups(P＜0.05);the plasma levels of D-dimer was lower than that of the control group,but there were no statistical difference between the two groups(P＞0.05).Conclusions Compare to the balanced ultrafiltration united modified ultrafiltration,the clinical application of venous-arterial continuous ultrafiltration throughout CPB can effectively increase the ultrafiltration speed,short the ultrafiltration time after CPB,remain the body temperature and dynamics target of bloodstream after CPB stable,exclude some harmful inflammatory mediators,protect and rapidly concentrate blood.PART3 Contrast study on the clinical effect of ultrafiltration with different bloodstream direction in protecting the main organ function and promoting the recovery after operationObjective Comparatively study on the clinical effect of ultrafiltration with different bloodstream direction in protecting the main organ function and promoting the recovery after operation.Methods Thirty patients with congenital heart diseases were randomly divided into two groups.In the control group,balanced ultrafiltration united modified ultrafiltration was used during CPB In the treated group, venous-medal continuous ultra_filtration was used throughout CPB.The serum concentrations of creatine kinase(CK),creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),ejection fraction(EF),heart rates(HR),jugular bulb venous oxygen saturation(SjvO₂),the arteriovenous oxygen difference(AVDO2),static pulmonary compliance(Cstat),airway resistence(Raw),alveolar-arterial oxygen difference(AaDO₂),chest drainage,transfusion of packed red blood cells and fresh frozen plasma,and duration of inotropic support,the mechanical ventilation support time and ICU stay time after operation were measured.Results After CPB,the serum concentrations of CK,CK-MB,and cTnI in the treated group was lower than that of the control group,there were statistical difference between the two groups(P＜0.05);The ejection fraction(EF) was increased,HR was decreased in the treated group compared with the control group,but there were no statistical difference between the two groups(P＞0.05);In the ultrafiltration period afcer CPB,the SjvO₂ was higher and the AVDO₂ was lower than that of the control group,there were statistical difference between the two groups(P＜0.05);The Cstat was increased,the Raw and the AaDO₂ were decreased,in the treated group compared with the control group,there were statistical difference between the two groups(P＜0.05);After operation,the chest drainage,and the transfusion of packed red blood cells and fresh frozen plasma was lower than that of the control group,there were statistical difference between the two groups(P＜0.05);The duration of inotropic support and the mechanical ventilation support time,ICU stay time was shorted in the treated group compared with the control group,there were statistical difference between the two groups(P＜0.05).Conclusions Compare to the balanced ultrafiltration united modified ultrafiltration,the application of venous-arterial continuous ultrafiltration throughout CPB can effectively attenuate the the main organ edema and injury, promote the recovery after operation.