临床评估五种膜式氧合器在不同温度下的跨膜压差.doc

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1、临床评估五种膜式氧合器在不同温度下的跨膜压差作者：刘瑞芳，邢家林，缪娜，柳薇，吉冰洋【摘要】目的评估五种中空纤维膜式氧合器(HFMO)在体外循环(CPB)中不同温度下的跨膜压差(TMPD)。方法40例择期CPB下行心脏直视手术患者依据使用HFMO的不同随机分为五组(每组8例)：A组(Affinty)，C组(Cobe)，J组(Jostra)，P组(Polystan)和T组(Terumo)。在CPB全流量后(T1)、最低温度时(T2)、复温后(T3)监测灌注流量、鼻咽温度、红细胞比积、平均动脉压，并在HFMO的入口和出口处监测压力的

2、变化。结果各组术前的临床参数没有显著性差异(P>0.05)。TMPD在不同的时点J组为最小，其他依次分别为A组0.05)。A组、P组和T组在低温过程中的TMPD分别高于T1和T3，但没有显著性差异(P>0.05)。结论J组和A组的TMPD较低可能更有利于减少对血细胞的破坏，更适合应用于CPB时间较长的心脏手术。【关键词】膜式氧合器;跨膜压差;体外循环;温度　　Abstract:OBJECTIVEToevaluatefivetypecommercialavailableoxygenatorsofthetrans-mem

3、branepressuredrop(TMPD)duringnormothermicandhypothermiccardiopulmonarybypass(CPB).METHODSFortypatientsscheduledforcardiacsurgeryparticipatedthisstudyandweredividedintofivegroups(n=8,inper-group)accordingtotypeofoxygenatorsusedduringCPB:groupJ(JoatraQuardox),groupA(Af

4、finityNT),groupP(PolystanSafeMaxi),groupT(TerumoCapioxSX)andgroupC(COBEAPEX-TM).ParameterswerecollectedduringCPBincludingmeanarterialpressure,pumpflow,temperature,hematocritandTMPDatpre-andpost-oxygenatorduringnormothermic(T1),hypothermic,28℃(T2)andafterrewarming(T3)

5、.RESULTSTherewasnosignificantdifferenceamongfivegroupsinpre-operativeclinicalparameters(P>0.05).TMPDsofgroupJwerethelowestindifferenttime-points,followedbytheothergroupweregroupA<groupP<groupT<groupC.TMPDofgroupJandAcomparedtotheotherthreegroupswerelower(

6、P<0.01)respectivelyandJwassignificantlowerthangroupAatT2(P<0.01).ExceptTMPDsofgroupPweresignificantlylowerthangroupC(P<0.01)atT1,therewerenostatisticalsignificance(P>0.05)invarioustime-points.AlthoughTMPDsingroupA,PandTduringT2werehigherthanT1andT3,butthe

7、rewerenostatisticalsignificance(P>0.05)invarioustime-points.CONCLUSIONTheTMPDofHFMOsingroupJandAproducedsignificantlylowerandduringnormothermicandhypothermicCPB,thusbloodtraumawiththesetwoHFMOsduringCPBmaybesignificantly4lowercomparedtotheotherthree.　　Keywords：Mem

8、braneoxygenato;Pressuredrop;Cardiopulmonarybypass;Hyperthermia　　随着生物医学工程技术的进步，中空纤维膜式氧合器(hollow-fibermembraneoxygenators,HFMO)的走血方式从