Objective To investigate the clinical effects and the management of combined using of zerobalanced ultrafiltration(ZBUF) and modified ultrafiltration(MUF) in severe infant open heart surgery with cardiopulmonary bypass(CPB) , in order to evaluate the feasibility and clinical significance of combination of ZBUF and MUF. Methods 20 pediatric patients diagnosed as complicated congenital heart disease had been involved, which included 12 males and 8 females with 12.6±7.5months of age and 8.5±3.3 kg of weight. Gambro FH22 hemofilter was selected in all patients. The typical MUF method was chosen. ZBUF was done during CPB and MUF was performed after CPB. The variety of hemodynamics, blood gas, concentration of electrolytes, inflammatory media and change of the plasma colloid osmotic pressure(COP) were measured at several time points. Filtrate was salvaged to detect the level of tumor necrosis factor alpha (TNF-α) and interleukine-8 (IL-8). Results Mean arterial pressure(MAP) was significantly higher(P=0.001) after MUF finished in all patients. Lactate acid (LAC), TNF-α and IL-8 had no significant difference before and after ZBUF. COP was significantly higher after MUF than that after ZBUF(P=0.002). Concentration of TNF-α in MUF filtrate was significantly higher than that in ZBUF(p=0.036). Conclusion Combined using of ZBUF and MUF has the effective ability of removing the inflammatory mediators and ameliorating system immunoreaction in pediatric CPB. MUF can improve the respiratory and heart function through decreasing the body water and increasing COP and hematocrit.
Zero-balanced uhrafihration; Stored blood; Priming solution; Infant; Heart surgery
ObjectiveTo evaluate the safety of modified blood-sparing approach in cardiac surgery with cardiopulmonary bypass (CPB) in low-weight infants (≤15 kg) with congenital heart disease. MethodsA total of 283 infants were applied a new blood-sparing approach, known as without homologous blood priming, during the cardiac surgery with CPB between August 2012 and October 2013. There were 154 males and 129 females with a median (interquartile range) age of 13 (9, 20) months. The infants were assigned to an intraoperative transfusion (IT) group once having transfusion during operation. And the infants without transfusion during operation were assigned to a postoperative transfusion (PT) group or a transfusion-free (TF) group according to post-operative transfusion. All infants experienced routine heart surgery with CPB. Blood samples were collected at following time points, ie. pre-CPB, 10 minutes after CPB, before termination of CPB, and after modified ultrafiltration. Clinical data and transfusion requirements were collected and compared between three groups. ResultsA total of 106 infants (53 males and 53 females) completed bloodless surgery. The median (interquartile range) age was 14 (9, 22) months. A total of 121 infants (71 males and 50 females) received red blood cell (RBC) transfusion intraoperatively. The median (interquartile range) age was 10 (8, 12) months. A total of 56 infants (30 males and 26 females) at age of 15 (7, 20) months received RBC transfusion postoperatively. The intraoperative transfusion (IT) group had lower body weight (9 (7,10) kg vs. 12.6 (9,14) kg) and size (72 (68, 80) cm vs. 86 (78, 97) cm), younger age (10 (8, 12) months vs. 14 (9, 22) months), and higher 24-hour chest tube drainage volume (89 (40, 122) ml vs. 58 (30, 106) ml, P<0.05) than those in the transfusion free (TF) group. Pre-operative hematocrit was also lower in the IT group than that in the PT group and the TF group (32% (29%, 37%) vs. 39% (34%, 41%) vs. 36% (33%, 38%), P<0.05). The hospital stay in the PT group and the IT group was longer than that in the TF group, respectively (13 (8, 23) d vs. 14 (11, 22) d vs. 11(8, 20) d, P<0.05). ConclusionAlthough applied with blood-sparing approach, perioperative transfusion is required in some infants. Infants who are free from transfusion have shorter hospital stay and less 24-hour chest tube drainage volume. Consideration of risk factors of transfusion in this population may benefit further reduction in blood transfusion in the future.
ObjectiveTo investigate the effect of artificial colloid on coagulation function in pediatric patients weighing less than 5 kg with congenital heart disease during cardiopulmonary bypass in congenital heart disease surgery by using artificial colloid instead of human serum albumin.MethodsA total of 65 pediatric patients with weight less than 5 kg who underwent congenital heart disease surgery in our hospital from September 2016 to December 2017 were included in the study. They were randomly divided into two groups: an artificial colloid group (the experimental group, n=33) and a human serum albumin combined artificial colloid group (the control group, n=32). Perioperative hemoglobin concentration (Hb), blood products and hemostatic drugs used, postoperative coagulation function index and pleural fluid volume 24 hours after surgery were monitored.ResultsThere was no significant difference in perioperative Hb and chest tube drainage between the two groups. The platelet utilization rate in the experimental group was significantly lower than that in the control group (P<0.05). No significant difference was found in the dosage of other blood products and hemostatic drugs between the two groups during the perioperative period. There was no significant difference in coagulation parameters between the two groups before and after surgery (P>0.05).ConclusionThe use of artificial colloid as colloid priming solution during cardiopulmonary bypass has no adverse effect on coagulation function in pediatric patients weighting less than 5 kg with congenital heart disease.