A Clinic Study Of Priming Modification In Infant Cardiopulmonary Bypass

ObjectiveTo evaluate the effects of prime solution modification on homeostasis of acid-base balance,electrolytes,systemic inflammatory mediators,hemodynamic state and physiologic index of cardiopulmonary bypass(CPB) and postoperative ICU in infant with congenital heart disease(CHD) undergoing open heart surgery.MethodsForty infants with Ventricular Septal Defect(VSD) whose weight between 5kg and 10kg underwent the open heart surgery were divided into two groups according to the random number table.Control group(n=20):stored blood was conventionally primed;Modified priming group(n=20):the ZBUF technique was used in priming solution based on the conventional stored blood priming.Lactated Ringer'S Solution were chosen as crystalloid priming solution and balance exchange solution. Ultrafiltration time were 28.0±1.5min and filtrated volume was 1000ml.Then adjusted the acid-base parameters to physiologic state according to blood gas and electrolyte analysis.Use the radio-immunity method to determine the inflammatory mediators including Tumor Necrosis Factor-alpha(TNF-α) and Interleukin-8(IL-8) of prime solution when 10min after the start of CPB,the termination of CPB,6 hours and 12 hours postoperatively.Compare the changes of the priming solution before and after the modification,CPB process and postoperative period in ICU such as pH, PCO₂,PO₂,BE,K⁺,Na⁺,Ca²⁺,HCT,SPO₂.Record and compare the length of heart beat well recovery after aortic cross clamp release,the variety of hemodynamic parameters,the chest drainage volume of total 48 hours after operation and the length of postoperative ventilation and ICU stay of two groups.ResultsAfter modification of conventional stored blood priming solution,TNF-αand IL-8 were lower than pre-modification and those in control group(P＜0.05),IL-8 at 10min after the start of CPB were lower than those in control group(P＜0.05) but TNF-αhad no statistic differences between two groups(P＞0.05),TNF-αand IL-8 at the termination of CPB and 6 hours postoperatively were lower than those in control group(P＜0.05),but they had no statistic differences between two groups(P＞0.05) at 12 hours after surgery,pH,PCO₂,BE and K⁺ in modified prime solution were improved better than those in control group(P＜0.05) and reach to physiological states. Blood gas and electrolyte results in CPB period were similar of two groups(P＞0.05), but 14 cases(70%) were used 5%NaHCO₃ to adjust BE in control group,whereas only 5 infants(25%) in modified groups had this adjustment(P＜0.05).The length of heart beat well recovery after aortic cross clamp release in modified group were shorter than those in control group(P＜0.05),and the length of postoperative ventilation were also shorter in modified group(P＜0.05).Blood gas and electrolyte parameters,hemodynamic state postoperatively,chest drainage volume of total 48 hours after operation and length of ICU stay of two groups had no statistic differences(P＞0.05).ConclusionsFor low body weight infants with CHD,the modification of CPB priming can take out of the inflammatory mediators from the conventional stored blood priming solution and prevent metabolic disturbances.The method to maintain intraoperative and postoperative homeostasis,attenuate the tissue edema postoperatively,decrease the SIRS and shorten the length of postoperative ventilation can make the CHD infants stability at peri-operation and be beneficial to the function of the main organs recovery from surgery,so it's a simple,effective and feasible intervention to attenuate the adverse effect of conventional stored blood priming solution of CPB in infants open heart surgery.