Lung Protection Due To Leukocyte-removed Priming Fluid Peri-cardiopulmonary Bypass In Infants

PrefaceAcute lung injury is a common complication after cardiopulmonary bypass in infants, and is closely related to the postoperative mortality and the success rate of heart surgery and treatment costs. Leukocytes have played a very important role in acute lung injury caused by cardiopulmonary bypass. Inhibiting the inflammatory response to reduce lung injury caused by Leukocytes removal is a reasonable strategy.The infant cardiopulmonary bypass surgery is necessary to add a certain number of banked blood-derived priming fluid, and the blood in the priming fluid is 2 to 3 times of the baby, So Leukocytes in priming fluid is great impact on the body of the baby. The study is through the removal of the Leukocytes in infant priming fluid to observe its effects on the pulmonary function due to cardiopulmonary bypass.ObjectiveThrough the removal of allogeneic leukocytes in priming fluid before cardiopulmonary bypass, it is discussed from various angles to make certain whether to reduce acute lung injury caused by the leukocyte-mediated inflammatory response during cardiopulmonary bypass. It provides a new approach to CPB lung protection in infants.MethodsSelected 60 cases of less than 1-year-old left-to-right shunt infants with congenital heart disease were assigned to the experimental group and control group according to age, weight, sex and disease. The experimental group took blood leukocyte-removal priming fluid, and the control group took banked blood-derived priming fluid. The plasma NE, TNF-α, IL-6, IL-8 levels were determinated by using ELISA at the corresponding period of cardiopulmonary bypass and WBC count were also determinated.Indicators of lung function before and after cardiopulmonary bypass in infants :TFI,lung C_dyn, P_peak, OI, PaO₂/PAO₂, A-aDO₂ and RI, were recorded. Ventilation and ICU time after operation were also recorded. By studying the differences in the two groups of indicators, results can be obtained by the use of statistical t test methods.Results1. Duration of mechanical ventilation and ICU after operation: the experimental group were significantly lower than the control group (P <0.01).2. WBC and inflammatory mediators: leukocyte count in the experimental group from aortic open 10 min to 24h after the CPB was lower than that in the control group (P<0.01); NE, TNF-a, IL-6 and IL-8 concentrations in the experimental group at many time points after CPB were lower than those in the control group (P <0.01, P <0.05).3. Pleural fluid index (TFI) at 2h, 6h after CPB in experimental group was obviously lower than that in the control group (P <0.05, P <0.01).4. Lung oxygenation indicators: OI and PaO₂/PAO₂ in experimental group both were higher than those in control group at 2h, 6h, 12h after CPB(P <0.05, P <0.01). A-aDO₂ in experimental group at 2h, 6h, 12h,48h after CPB was lower than that in control group (P <0.01, P <0.05). At 6h, 12h after CPB RI in experimental group was lower than that in control group (P <0.05, P <0.01).5. Lung ventilation indicators: peak airway pressure (P_peak) in the experimental group at 2h after CPB was lower than that in the control group (P <0.01), dynamic lung compliance (Cdyn) in the experimental group at 2h after CPB was higher than that in control group (P <0.05).Conclusions1. The measure of leukocyte-removed priming fluid peri-CPB in infants can reduce the number of leukocytes, and decrease the plasma levels of inflammatory mediators NE, TNF-a, IL-6 and IL-8 reducing CPB-mediated inflammatory response.2. The measure of leukocyte-removed priming fluid peri-CPB in infants can reduce acute lung injury caused by the inflammatory response during CPB, and improve lung function of oxygenation and ventilation, and reduce the duration of mechanical ventilation and ICU after operation, and provide a good protection for lung function after CPB.