| Objective:Cardiopulmonary bypass(CPB)initiated with high oxygen levels may expose cyanotic children to reoxygenation injury.The ideal method of initiation of bypass to prevent this phenomenon still remains largely unproven.This study tested the hypothesis that controlling oxygenation during initiation of CPB improves early postoperative outcomes.Methods:We analyzed 47 children diagnosed of cyanotic congenital heart disease in Shanghai Children’s Medical Center,during March 2017-December2019.Their average age was 3.1 years.47 children were randomly divided into 3 groups: hyperoxeic,graded reoxygenation,normoxic reoxygenation.Near Infrared Spectrum Instrument(NIRS)was used to monitor brain oxygen saturation.Blood samples were collected on 6 time:pre-operation,pre-CPB,CPB on 5 minus,rewarm,CPB-end,post-operation 24 hours.Serum concentration of GFAP and was analyzed by shanghai jike company.Results: A total of 47 children were included in this study,including 30 males and 17females;aged 0 ～ 60 months,with an average age of 17.31 ± 18.96 months;height 48～ 125 cm,with an average height of 75.18 ± 18.48cm;and a weight of 2.5kg ～ 21 kg,with an average of 9.13 ± 4.42 kg.The computer was randomly divided into 3 groups,and the children in the three groups were similar in age and weight. GFAP:There was no significant difference in serum GFAP levels between the three observation groups on pre-OP and pre-CPB.The average level of each group increased significantly,but the increase in the high oxygen group was significantly greater than that of the other two groups on the time of rewarm.on the time of end of CPB,all three groups decreased,and the hyperoxia group was still significantly higher than the other two groups.At 24 hours after surgery,the GFAP levels of the three groups of children decreased significantly,but still significantly higher than before surgery. MDA: The children in the three groups were at a low level on the time of pre-OP and pre-CPB,and there was no statistical difference between the groups.On the time of CPB on 5mins,the MDA level of the three groups of children began to increase,of which the hypoxic group had the most obvious increase compared to the other two groups(p <0.05).At the end of CPB,all three groups decreased.The hypoxic group and the hyperoxic group decreased to similar levels,but significantly higher than the progressive oxygen group(p <0.05).24 hours after surgery,the hypoxic group had no significant decrease compared to the end of CPB,but it was still higher than the other two groups(p <0.05). IL: There were no significant differences at different time points in the same observation group and between different groups at the same time point.Conclusion: Compared with the hyperoxic group,gradual oxygenation in children with cyanotic CHD during CPB can reduce the levels of GFAP and MDA,which is beneficial to reduce brain damage;compared with the hypoxic group,group of gradual oxygenation is more conducive to the recovery of brain injury.It is suggested that gradual oxygenation is more conducive to perioperative brain protection than the other two methods. |
