| Background and objective:Clinical doctor applicated blood priming in cardiopulmonary hypass(CPB) in the initial stage of cardiac surgery unilizing CPB in the early 1950's. They dicovered that blood priming led to blood injuryed seriously and the demand in homologous blood increasing and the clinical synthetic symptom of transfusion. Crystal fluid and colloid fluid priming was unilized successfully and was generalized extensively in clinic in 1970's.It decreases greatly the complications after CPB and the requirment of homologous blood .The fliud priming in CPB dcreases blood viscifity and increases blood relocity in subtle circulation and reduces complications after CPB and conserves a large quality of homologous blood. But exorbitant hemodilution leads to the deficiency of oxygen and dropsy of important organs and the function of important organs (such as heart brain kidney)injuryed.Therefore ,it is important to definite a reasonable and safety hemodilution extent by means of a series of clinic and experiment research.Many academicans thinks that hemodilution extent that HCT < 20% is a danger line in cardiac surgery.But recently some academicans discovered that extereme hemodilution of HCT 15-20% were safety in clinic.There is objections on safe of extereme hemodilution. CPB can lead to cerebral injury of different extent .Cerebralinjury extent after CPB is a sensitive index of reflecting entire priming of CPB. S100 B protein and NSE are neurobiochemistry markers existing in center nerve systems and are effective monitor indexs evalutating cerebral cell injury. In recently years ,it was discovered that S100β protein and NSE increased obviously after CPB, S100β protein and NSE in plasma were effective monitor indexs evaluating cerebral injury after CPB.This study attempted to discuss the effect of extreme hemodilution on cerebral injury through assays S100β protein and NSE levels in plasma during the peri-cardipulmonary bypass and to provided evidences to definite reasonable and safe hemodilution externt.Methods:Twenty rheumatic cardiac valve patients planned to be opereated DVR or MVR divived into moderate hemodilution group (control group , HCT25-30% in CPB) and extreme hemodilution group (experiment group ,HCT15-20%in CPB) , blood samples were taken from internal juguar rein before operation(A), 20min after the beginning of CPB(B),at the cessation of CPB(C),30minute(D)5hour(E) and 24hour(F) after CPB,to measure plasma levels of S100β protein and NSE.Mini-mental state examination(MMSE) scores was performed one day before surgery and on day one after the operation and on day five after the operation .The blood volume released before CPB ,time of wakening and mechanical ventilatory support,days in ICU and in hospital after operation ,the volume of homologous blood were recorded in tra-operatively and post-operatively.Results: (1) All patients survived the surgery and were discharged in good condition .No complication directely attributable to the hemodilution were observed .There were no statistical difference in patient characteristics between morderate hemodilution group and extreme hemodilntion group.(2)There were no difference between two groups in the levels of S100β protein in all times (P>0.05).The levels of S100β protein increased significantly in both groups 20minute after the beginning of CPB compared with baseline values (P<0.01),and reach peak level at cessation of CPB(P<0.01),and decreased significantly 5hour after CPB compared withpeak values(P<0.05),and there were no difference with baseline value 24 hour after CPB(P<0.05).(3)There were no difference between two groups in the levels of NSE in all times (P>0.05).The levels of NSE increased significantly in both group 20minute after the beginning of CPB compared with baseline values(P<0.01) and reached peak values 30minute after CPB(P<0.01)and increased significantly 5hour after CPB compare with peak values(P<0.01),and there was no difference with baseline value 24hour after CPB(P>0.05). (4)The time of aorta blocked up and the tim...
|
PDF Full Text Request