不同血流方向超滤方式在婴幼儿体外循环中临床应用系列研究
|
摘要
体外循环(CPB)中的血液稀释会造成血浆白蛋白浓度及胶体渗透压降低,同时由于低温、血液和异物表面的接触以及血流动力学的改变、器官缺血及再灌注损伤等多种原因,激活体内应激反应系统,其中包括中性粒细胞、血小板、凝血、激肽、补体等系统的激活,从而引起全身炎症反应综合征(SIRS)和水肿。血液激活产生和释放的炎症介质是促成炎症反应和器官损伤的重要物质基础,在CPB灌注期间和之后释放较明显的细胞因子主要有肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和白介素-8(IL-8)等,如果被激活的炎症反应失控,又未能及时有效地治疗,炎症反应将不断放大,最终可导致多脏器功能衰竭。
超滤作为CPB的一项重要技术,它最主要的作用是能有效地浓缩血液和排除CPB中生成的大量炎症介质。目前,常用的超滤方法有常规超滤(CUF)、平衡超滤(BUF)及改良超滤(MUF)等。由于婴幼儿体外循环预充量少,受储血器平面的限制,常规超滤浓缩血液的效果不理想,炎症介质的滤出也有限。平衡超滤方式是在CPB过程中超滤出液体的同时补充晶体液,以维持储血器平面,其滤出CPB过程中大量生成的炎症介质的效果明显提高,但该方法没有浓缩血液的功能。1991年Naik等创立了在转流结束时动脉一静脉方向超滤的改良超滤方式(A-V MUF),其不受储血器平面的限制,浓缩血液的效率大为提高,但其滤出炎症介质的作用有限。为此,有学者采用平衡超滤联合改良超滤的方式,该方式组合了两者的优点,可有效滤出炎症介质、快速浓缩血液,但仍无法避免手术时间延长,改良超滤期间无法对血液升温,造成人为的左向右分流的缺点,不利于体温回升和循环状态稳定。可能引起肺多血、体循环灌注不足以及患儿体温下降,常需同时泵入机血以维持血压,容易导致主动脉插管内血液流向不断的变化,甚至发生气穴而造成危害。有研究表明改良超滤期间由于左向右的分流产生主动脉窃血,可引起脑血流量及静脉血氧饱和度的降低,其潜在不利因素包括主动脉窃血,动脉端进气,流量受限制,难以保证满意的灌注压力、体温、血氧饱和度,以及低温对心肌产生损害等。而且由于平衡超滤方式需反复将血液氧合、变温、超滤后注入储血器,理论上增加了血液的破坏和炎症细胞因子的生成。
采取更符合生理,更有效地排除炎性介质,浓缩血液,缩短手术时间,减少对机体的不良刺激,有利于机体生理状态稳定的超滤方式对于提高手术质量具有重要意义。理论上分析,静脉-动脉方向持续超滤可结合各类传统超滤方式的优点,克服传统超滤方式的以上缺点。为此,本课题临床应用了静脉-动脉方向超滤方式,并对比研究不同血流方向超滤方式在婴幼儿体外循环中临床应用对超滤时间,滤水速度、体温、血流动力学、血液浓缩、血液保护、炎症细胞因子的排除、心肺脑等重要脏器功能保护及术后恢复的影响,探讨不同血流方向超滤方式对减轻CPB后重要脏器损伤和水肿,促进术后恢复的效果及机理。类似研究国内外尚未见报道。
第一部分婴幼儿体外循环后V-A MUF与A-V MUF临床应用的对照研究
目的对照研究婴幼儿体外循环后静脉-动脉方向超滤(V-A MUF)与动脉-静脉方向超滤(A-V MUF)的临床应用对浓缩血液,排除炎症介质,缩短手术时间,维持体温、血流动力学稳定,防止和减轻体外循环后重要脏器水肿和损伤的效果。方法将30例先天性心脏病患儿随机分成对照组和实验组,对照组体外循环结束后应用A-V MUF;实验组在体外循环结束后应用V-A MUF,观察患儿的超滤时间、滤水速度,超滤期间体温、血流动力学变化,超滤后红细胞压积(HCT)、血浆白蛋白浓度、炎症介质肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)的血浆浓度、肺静态顺应性(Cstat)、气道阻力(Raw)、肺泡-动脉氧分压梯度(AaDO_2)等指标的变化。结果与对照组比较,实验组滤水速度提高,超滤时间和手术时间缩短,两者比较差异有统计学意义(P＜0.01);实验组超滤期间体温、动脉血压稳定(P＜0.05);CPB结束后5 min,10min,红细胞压积(HCT)和白蛋白血浆浓度均明显高于对照组(P＜0.05);CPB结束后20分钟,两者比较差异无统计学意义(P＞0.05);两组超滤结束后肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)血浆浓度均下降,但两者比较差异无统计学意义(P＞0.05);实验组术后肺静态顺应性(Cstat)提高、气道阻力(Raw)、肺泡-动脉氧分压梯度(AaDO_2)下降,组间比较差异有统计学意义(P＜0.05)。结论比较A-V MUF,体外循环后采用V-AMUF,可快速地浓缩血液,缩短手术时间,有利于体温、血流动力学的稳定,改善肺功能。
第二部分不同血流方向持续超滤方式对体外循环超滤时间、滤水速度、体温、血流动力学、血液浓缩、血液保护及炎症介质排除的影响
目的研究不同血流方向持续超滤方式的临床应用,对体外循环超滤时间、滤水速度、体温、血流动力学、血液浓缩、血液保护以及炎症介质排除的影响。方法将30例先天性心脏病患者随机分成两组,CPB术中对照组应用平衡超滤联合改良超滤,实验组应用静脉-动脉方向持续超滤。观察患儿的超滤时间、滤水速度,超滤期间体温、血流动力学变化,超滤后红细胞压积(HCT)、血浆白蛋白浓度、游离血红蛋白、D-二聚体、肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)的血浆浓度等指标的变化.结果静脉-动脉方向持续超滤组较平衡超滤联合改良超滤组滤水速度提高,停CPB后超滤时间明显缩短(P＜0.01);停CPB后超滤期间体温、动脉血压稳定(P＜0.05);CPB结束后5 min,红细胞压积(HCT)和白蛋白血浆浓度明显高于平衡超滤联合改良超滤组(P＜0.01);CPB结束时以及CPB结束后10min,红细胞压积(HCT)和白蛋白浓度高于平衡超滤联合改良超滤组(P＜0.05);CPB结束后20min,两者比较差异无统计学意义(P＞0.05);CPB结束后,静脉-动脉方向持续超滤组白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)血浆浓度低于平衡超滤联合改良超滤组(P＜0.05);游离血红蛋白血浆浓度(FHb)低于平衡超滤联合改良超滤组(P＜0.05);D-二聚体血浆浓度低于平衡超滤联合改良超滤组,但两者比较差异无统计学意义(P＞0.05)。结论比较平衡超滤联合改良超滤,CPB采用静脉-动脉方向持续超滤,可有效地提高滤水速度,缩短超滤及手术时间,有利于停CPB后超滤期间体温、血流动力学的稳定,更有效地排除部分炎症介质,浓缩血液,减轻血液破坏。
第三部分不同血流方向持续超滤方式对体外循环重要脏器功能的保护及术后恢复的影响
目的研究静脉-动脉方向持续超滤在婴幼儿体外循环心内直视手术中的应用对体外循环重要脏器功能的保护及术后恢复的影响。方法将30例先天性心脏病患儿随机分成对照组和实验组,CPB术中对照组应用平衡超滤联合改良超滤,实验组应用静脉-动脉方向持续超滤。观察患儿心肌肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、心肌肌钙蛋白I(cTnI)的血浆浓度、左室射血分数(EF)、心率(HR)、颈内静脉球血氧饱和度(SjVO_2)、动脉与颈内静脉球血氧含量差(AVDO_2)、动脉、颈内静脉球血浆乳酸浓度差(AVDL)、肺静态顺应性(Cstat)、气道阻力(Raw)、肺泡-动脉氧分压梯度(AaDO_2)的变化,以及术后24小时出血量、输血量、血管活性药物应用时间、呼吸机辅助时间和住ICU时间等指标。结果与对照组相比,实验组体外循环后心肌肌酸激酶(CK)、CK同功酶(CK-MB)、心肌肌钙蛋白I(cTnI)血浆浓度均降低,两组比较差异有统计学意义(P＜0.05);两组射血分数(EF)及心率(HR)差异无统计学意义(P＞0.05);CPB后超滤期间颈静脉血氧饱和度(SjVO_2)高于对照组,动脉、颈内静脉球血氧含量差(AVDO_2)低于对照组,两组比较差异有统计学意义(P＜0.05);两组动脉、颈内静脉球血浆乳酸浓度差(AVDL)各时点差异无统计学意义(P＞0.05);CPB结束后,与对照组相比,实验组气道阻力(Raw)、肺泡-动脉氧分压梯度(AaDO_2)均降低,肺静态顺应性(Cstat)升高,两组间比较差异有统计学意义(P＜0.05);术后24小时出血量、输血量均减少(P＜0.05);术后血管活性药物应用时间、呼吸机辅助时间和住ICU时间均缩短,两组间比较差异有统计学意义(P＜0.05)。结论比较平衡超滤联合改良超滤,体外循环中采用静脉-动脉方向持续超滤,可有效地减轻心脑肺等重要脏器水肿和损伤,促进术后恢复。
Hemodilution used for cardiopulmonary bypass(CPB) decreases serum albumin concentration and colloid osmotic pressure and increases the capillary effective filtration pressure,leading to the accumulation of plasma water in the interstitial space. During cardiopulmonary bypass(CPB),blood first contacts the foreign surface of the extracorporeal circuit,ischemia of organs and reperfusion injury lead to activate the blood,including polymorphonuelearleukocyte,platelet,coagulation,kinin,and complement systems.And inflammator radiators release,the systemic inflammatory response is initiated.The mediators are main materials which elicit inflammatory response and organ injury.The behavior of cytokine production,mainly including tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6) and interleukin-8(IL-8).If the activated inflammatory response were out of control,and did not treated effectively,the multiple organs failure will be the result.
Ultrafiltration is an important technique for CPB.It is mainly used in filtrating water,concentrating blood,and eliminating inflamatory mediators of low and middle molecules also,In generally,methods of ultrafiltration include conventional ultrafiltration(CUF),balanced ultrafiltration(BUF)and modified ultrafiltration(MUF). Since1970's,conventional ultrafiltration has been suggested as a means of reducing fluid accumulation.But it has not been proved satisfactory in young patients because of a relatively lower volume in the venous reservoir.Because the ultrfiltration can remove some harmful medium-size inflammatory mediators and relieve inflammatory response,Thus balanced ultrafiltration was originated,which is used throughout CPB to remove harmful medium-size solutes.Crystalloid solution is needed to keep a safe volume in the reservoir.But it haven't the ability to concentrate blood.In 1991,a modified method was reported by Naik,with advantages of being less limited by the level of fluid in the venous reservoir and more suitable to young patients.But the ability to relieve inflammatory factors was limited.So,in resent years,balanced ultrafiltration united modified ultrafiltration was used to combine the advantages of balanced ultrafiltration and modified ultrafiltration.But the MUF circuit produces an increased diastolic runoff from the aorta that steals flow from the cerebral circulation. It may decrease cerebral blood flow velocities and transcranial mixed venous oxygen saturations.Other possible disadvantages of this system include:(1) the potential for air entrainment at the aortic cannulation site,(2) limitations of flow due to the aortic size,(3) significant arterial to venous shunts,and(4) difficulty in maintaining desired filling pressure,temperature,and blood oxygen saturation.
We think that using a venous-arterial continuous ulrtrafiltration system may avoid these potential disadvantages,and combine the advantages of traditional ultrafiltration mentioned above.So,in this article,the clinical application of venous-arterial ulrtrafiltration system was studied compared with arterial-venous ulrtrafiltration system.To investigate the effect and mechanism of ultrafiltration with different bloodstream derection in attenuating the the main organ edema and injury, and promoting the recovery after operation.There is no similar article reporting. PART1 Contrast study in the clinical application of V-A MUF and A-V MUF after cardiopulmonary bypass in infants
Objective Comparatively study in the clinical application of venous-arterial modified ultrafiltration(V-A MUF) and arterial-venous modified ultrafiltration(A-V MUF) after cardiopulmonary bypass in infants.To evaluate their effects in concentrating blood,excluding harmful inflammatory mediators,shorting operation time,remaining the body temperature and dynamics target of bloodstream stable, preventing and relieving the main organ edema and injury that may follow open heart surgery with cardiopulmonary bypass(CPB).Methods Thirty infants with congenital heart diseases were randomly divided into two groups.In the control group,A-V MUF was used after cardiopulmonary bypass.In the treated group,V-A MUF technique was used after cardiopulmonary bypass.The ultrafiltration time, ultrafiltration speed,body temperature,dynamics target of bloodstream,the serum concentrations of albumin and hematocrit,the serum concentration of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6),static pulmonary compliance (Cstat),airway resistence(Raw),alveolar-arterial oxygen difference(AaDO_2) were measured.Results The ultrafiltration speed was increased,MUF time and operation time was shorted in the treated group compared with the control group,there were statistical difference between the two groups(P＜0.01);In the MUF period,the body temperature and arterial pressure were stable,there were statistical difference between the two groups(P＜0.05);At the 5 minutes,10 minutes after the termination of CPB,the hematocrit and serum albumin concentrations were increased in the treated group compared with the control group,there were statistical difference between the two groups(P＜0.05);At the 20 minutes after the termination of CPB,there were no statistical difference between the two groups(P＞0.05);After MUF,the serum concentration of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6) were all decreased in the two groups,but there were no statistical difference between the two groups(P＞0.05);After MUF,the static pulmonary compliance(Cstat)was increased,airway resistence(Raw) and alveolar-arterial oxygen difference(AaDO_2) were decreased in the treated group compared with the control group(P＜0.05).
Conclusions Compare to the A-V MUF,the clinical application of V-A MUF can effectively short MUF time and operation time,concentrate blood,remain the body temperature and dynamics target of bloodstream stable,attenuate lung edema and injury.
PART2 Contrast study on the influence of ultrafiltration with different bloodstream direction in ultrafiltration time,ultrafiltration speed,body temperature,dynamics target of bloodstream,blood protection,blood concentrating and inflammatory mediators excluding during open heart surgery with cardiopulmonary bypass in infants
Objective Comparatively study on the influence of ultrafiltration with different bloodstream direction in ultrafiltration time,ultra:filtration speed,body temperature, dynamics target of bloodstream,blood protection,blood concentrating and inflammatory mediators excluding during open heart surgery with cardiopulmonary bypass in infants.Methods Thirty patients with congenital heart diseases were randomly divided into two groups.In the control group,balanced ultrafiltration united modified ultrafiltration was used during CPB.In the treated group,venous-medal continuous ultrafiltration was used throughout CPB.The ultrafiltration time, ultrafiltration speed,body temperature,dynamics target of bloodstream,the serum concentration of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6),the serum concentrations of albumin and hematocrit,the plasma levels of D-dimer and free hemoglobin(FHb) were measured.Results The ultrafiltration speed was increased and the ultrafiltration time after CPB was significantly shorted in the treated group compared with the control group(P＜0.01);In the ultrafiltration period after CPB,the body temperature and arterial pressure were stable,there were statistical difference between the two groups(P＜0.05);After ultrafiltration,the serum concentrations of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6) were decreased in the treated group compared with the control group(P＜0.05);At the 5 minutes after after the termination of CPB,the hematocrit and serum albumin concentrations were significantly increased in the treated group compared with the control group(P＜0.01);At the termination of CPB and the 10 minutes after the termination of CPB,the hematocrit and serum albumin concentrations were increased in the treated group compared with the control group(P＜0.05);At the 20 minutes after the termination of CPB,there were no statistical difference between the two groups(P＞0.05);The serum concentrations of free hemoglobin(FHb) in the treated group was lower than that of the control group,there were statistical difference between the two groups(P＜0.05);the plasma levels of D-dimer was lower than that of the control group,but there were no statistical difference between the two groups(P＞0.05).Conclusions Compare to the balanced ultrafiltration united modified ultrafiltration,the clinical application of venous-arterial continuous ultrafiltration throughout CPB can effectively increase the ultrafiltration speed,short the ultrafiltration time after CPB,remain the body temperature and dynamics target of bloodstream after CPB stable,exclude some harmful inflammatory mediators,protect and rapidly concentrate blood.
PART3 Contrast study on the clinical effect of ultrafiltration with different bloodstream direction in protecting the main organ function and promoting the recovery after operation
Objective Comparatively study on the clinical effect of ultrafiltration with different bloodstream direction in protecting the main organ function and promoting the recovery after operation.Methods Thirty patients with congenital heart diseases were randomly divided into two groups.In the control group,balanced ultrafiltration united modified ultrafiltration was used during CPB In the treated group, venous-medal continuous ultra_filtration was used throughout CPB.The serum concentrations of creatine kinase(CK),creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),ejection fraction(EF),heart rates(HR),jugular bulb venous oxygen saturation(SjvO_2),the arteriovenous oxygen difference(AVDO2),static pulmonary compliance(Cstat),airway resistence(Raw),alveolar-arterial oxygen difference(AaDO_2),chest drainage,transfusion of packed red blood cells and fresh frozen plasma,and duration of inotropic support,the mechanical ventilation support time and ICU stay time after operation were measured.Results After CPB,the serum concentrations of CK,CK-MB,and cTnI in the treated group was lower than that of the control group,there were statistical difference between the two groups(P＜0.05);The ejection fraction(EF) was increased,HR was decreased in the treated group compared with the control group,but there were no statistical difference between the two groups(P＞0.05);In the ultrafiltration period afcer CPB,the SjvO_2 was higher and the AVDO_2 was lower than that of the control group,there were statistical difference between the two groups(P＜0.05);The Cstat was increased,the Raw and the AaDO_2 were decreased,in the treated group compared with the control group,there were statistical difference between the two groups(P＜0.05);After operation,the chest drainage,and the transfusion of packed red blood cells and fresh frozen plasma was lower than that of the control group,there were statistical difference between the two groups(P＜0.05);The duration of inotropic support and the mechanical ventilation support time,ICU stay time was shorted in the treated group compared with the control group,there were statistical difference between the two groups(P＜0.05).Conclusions Compare to the balanced ultrafiltration united modified ultrafiltration,the application of venous-arterial continuous ultrafiltration throughout CPB can effectively attenuate the the main organ edema and injury, promote the recovery after operation.
超滤作为CPB的一项重要技术,它最主要的作用是能有效地浓缩血液和排除CPB中生成的大量炎症介质。目前,常用的超滤方法有常规超滤(CUF)、平衡超滤(BUF)及改良超滤(MUF)等。由于婴幼儿体外循环预充量少,受储血器平面的限制,常规超滤浓缩血液的效果不理想,炎症介质的滤出也有限。平衡超滤方式是在CPB过程中超滤出液体的同时补充晶体液,以维持储血器平面,其滤出CPB过程中大量生成的炎症介质的效果明显提高,但该方法没有浓缩血液的功能。1991年Naik等创立了在转流结束时动脉一静脉方向超滤的改良超滤方式(A-V MUF),其不受储血器平面的限制,浓缩血液的效率大为提高,但其滤出炎症介质的作用有限。为此,有学者采用平衡超滤联合改良超滤的方式,该方式组合了两者的优点,可有效滤出炎症介质、快速浓缩血液,但仍无法避免手术时间延长,改良超滤期间无法对血液升温,造成人为的左向右分流的缺点,不利于体温回升和循环状态稳定。可能引起肺多血、体循环灌注不足以及患儿体温下降,常需同时泵入机血以维持血压,容易导致主动脉插管内血液流向不断的变化,甚至发生气穴而造成危害。有研究表明改良超滤期间由于左向右的分流产生主动脉窃血,可引起脑血流量及静脉血氧饱和度的降低,其潜在不利因素包括主动脉窃血,动脉端进气,流量受限制,难以保证满意的灌注压力、体温、血氧饱和度,以及低温对心肌产生损害等。而且由于平衡超滤方式需反复将血液氧合、变温、超滤后注入储血器,理论上增加了血液的破坏和炎症细胞因子的生成。
采取更符合生理,更有效地排除炎性介质,浓缩血液,缩短手术时间,减少对机体的不良刺激,有利于机体生理状态稳定的超滤方式对于提高手术质量具有重要意义。理论上分析,静脉-动脉方向持续超滤可结合各类传统超滤方式的优点,克服传统超滤方式的以上缺点。为此,本课题临床应用了静脉-动脉方向超滤方式,并对比研究不同血流方向超滤方式在婴幼儿体外循环中临床应用对超滤时间,滤水速度、体温、血流动力学、血液浓缩、血液保护、炎症细胞因子的排除、心肺脑等重要脏器功能保护及术后恢复的影响,探讨不同血流方向超滤方式对减轻CPB后重要脏器损伤和水肿,促进术后恢复的效果及机理。类似研究国内外尚未见报道。
第一部分婴幼儿体外循环后V-A MUF与A-V MUF临床应用的对照研究
目的对照研究婴幼儿体外循环后静脉-动脉方向超滤(V-A MUF)与动脉-静脉方向超滤(A-V MUF)的临床应用对浓缩血液,排除炎症介质,缩短手术时间,维持体温、血流动力学稳定,防止和减轻体外循环后重要脏器水肿和损伤的效果。方法将30例先天性心脏病患儿随机分成对照组和实验组,对照组体外循环结束后应用A-V MUF;实验组在体外循环结束后应用V-A MUF,观察患儿的超滤时间、滤水速度,超滤期间体温、血流动力学变化,超滤后红细胞压积(HCT)、血浆白蛋白浓度、炎症介质肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)的血浆浓度、肺静态顺应性(Cstat)、气道阻力(Raw)、肺泡-动脉氧分压梯度(AaDO_2)等指标的变化。结果与对照组比较,实验组滤水速度提高,超滤时间和手术时间缩短,两者比较差异有统计学意义(P＜0.01);实验组超滤期间体温、动脉血压稳定(P＜0.05);CPB结束后5 min,10min,红细胞压积(HCT)和白蛋白血浆浓度均明显高于对照组(P＜0.05);CPB结束后20分钟,两者比较差异无统计学意义(P＞0.05);两组超滤结束后肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)血浆浓度均下降,但两者比较差异无统计学意义(P＞0.05);实验组术后肺静态顺应性(Cstat)提高、气道阻力(Raw)、肺泡-动脉氧分压梯度(AaDO_2)下降,组间比较差异有统计学意义(P＜0.05)。结论比较A-V MUF,体外循环后采用V-AMUF,可快速地浓缩血液,缩短手术时间,有利于体温、血流动力学的稳定,改善肺功能。
第二部分不同血流方向持续超滤方式对体外循环超滤时间、滤水速度、体温、血流动力学、血液浓缩、血液保护及炎症介质排除的影响
目的研究不同血流方向持续超滤方式的临床应用,对体外循环超滤时间、滤水速度、体温、血流动力学、血液浓缩、血液保护以及炎症介质排除的影响。方法将30例先天性心脏病患者随机分成两组,CPB术中对照组应用平衡超滤联合改良超滤,实验组应用静脉-动脉方向持续超滤。观察患儿的超滤时间、滤水速度,超滤期间体温、血流动力学变化,超滤后红细胞压积(HCT)、血浆白蛋白浓度、游离血红蛋白、D-二聚体、肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)的血浆浓度等指标的变化.结果静脉-动脉方向持续超滤组较平衡超滤联合改良超滤组滤水速度提高,停CPB后超滤时间明显缩短(P＜0.01);停CPB后超滤期间体温、动脉血压稳定(P＜0.05);CPB结束后5 min,红细胞压积(HCT)和白蛋白血浆浓度明显高于平衡超滤联合改良超滤组(P＜0.01);CPB结束时以及CPB结束后10min,红细胞压积(HCT)和白蛋白浓度高于平衡超滤联合改良超滤组(P＜0.05);CPB结束后20min,两者比较差异无统计学意义(P＞0.05);CPB结束后,静脉-动脉方向持续超滤组白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)血浆浓度低于平衡超滤联合改良超滤组(P＜0.05);游离血红蛋白血浆浓度(FHb)低于平衡超滤联合改良超滤组(P＜0.05);D-二聚体血浆浓度低于平衡超滤联合改良超滤组,但两者比较差异无统计学意义(P＞0.05)。结论比较平衡超滤联合改良超滤,CPB采用静脉-动脉方向持续超滤,可有效地提高滤水速度,缩短超滤及手术时间,有利于停CPB后超滤期间体温、血流动力学的稳定,更有效地排除部分炎症介质,浓缩血液,减轻血液破坏。
第三部分不同血流方向持续超滤方式对体外循环重要脏器功能的保护及术后恢复的影响
目的研究静脉-动脉方向持续超滤在婴幼儿体外循环心内直视手术中的应用对体外循环重要脏器功能的保护及术后恢复的影响。方法将30例先天性心脏病患儿随机分成对照组和实验组,CPB术中对照组应用平衡超滤联合改良超滤,实验组应用静脉-动脉方向持续超滤。观察患儿心肌肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、心肌肌钙蛋白I(cTnI)的血浆浓度、左室射血分数(EF)、心率(HR)、颈内静脉球血氧饱和度(SjVO_2)、动脉与颈内静脉球血氧含量差(AVDO_2)、动脉、颈内静脉球血浆乳酸浓度差(AVDL)、肺静态顺应性(Cstat)、气道阻力(Raw)、肺泡-动脉氧分压梯度(AaDO_2)的变化,以及术后24小时出血量、输血量、血管活性药物应用时间、呼吸机辅助时间和住ICU时间等指标。结果与对照组相比,实验组体外循环后心肌肌酸激酶(CK)、CK同功酶(CK-MB)、心肌肌钙蛋白I(cTnI)血浆浓度均降低,两组比较差异有统计学意义(P＜0.05);两组射血分数(EF)及心率(HR)差异无统计学意义(P＞0.05);CPB后超滤期间颈静脉血氧饱和度(SjVO_2)高于对照组,动脉、颈内静脉球血氧含量差(AVDO_2)低于对照组,两组比较差异有统计学意义(P＜0.05);两组动脉、颈内静脉球血浆乳酸浓度差(AVDL)各时点差异无统计学意义(P＞0.05);CPB结束后,与对照组相比,实验组气道阻力(Raw)、肺泡-动脉氧分压梯度(AaDO_2)均降低,肺静态顺应性(Cstat)升高,两组间比较差异有统计学意义(P＜0.05);术后24小时出血量、输血量均减少(P＜0.05);术后血管活性药物应用时间、呼吸机辅助时间和住ICU时间均缩短,两组间比较差异有统计学意义(P＜0.05)。结论比较平衡超滤联合改良超滤,体外循环中采用静脉-动脉方向持续超滤,可有效地减轻心脑肺等重要脏器水肿和损伤,促进术后恢复。
Hemodilution used for cardiopulmonary bypass(CPB) decreases serum albumin concentration and colloid osmotic pressure and increases the capillary effective filtration pressure,leading to the accumulation of plasma water in the interstitial space. During cardiopulmonary bypass(CPB),blood first contacts the foreign surface of the extracorporeal circuit,ischemia of organs and reperfusion injury lead to activate the blood,including polymorphonuelearleukocyte,platelet,coagulation,kinin,and complement systems.And inflammator radiators release,the systemic inflammatory response is initiated.The mediators are main materials which elicit inflammatory response and organ injury.The behavior of cytokine production,mainly including tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6) and interleukin-8(IL-8).If the activated inflammatory response were out of control,and did not treated effectively,the multiple organs failure will be the result.
Ultrafiltration is an important technique for CPB.It is mainly used in filtrating water,concentrating blood,and eliminating inflamatory mediators of low and middle molecules also,In generally,methods of ultrafiltration include conventional ultrafiltration(CUF),balanced ultrafiltration(BUF)and modified ultrafiltration(MUF). Since1970's,conventional ultrafiltration has been suggested as a means of reducing fluid accumulation.But it has not been proved satisfactory in young patients because of a relatively lower volume in the venous reservoir.Because the ultrfiltration can remove some harmful medium-size inflammatory mediators and relieve inflammatory response,Thus balanced ultrafiltration was originated,which is used throughout CPB to remove harmful medium-size solutes.Crystalloid solution is needed to keep a safe volume in the reservoir.But it haven't the ability to concentrate blood.In 1991,a modified method was reported by Naik,with advantages of being less limited by the level of fluid in the venous reservoir and more suitable to young patients.But the ability to relieve inflammatory factors was limited.So,in resent years,balanced ultrafiltration united modified ultrafiltration was used to combine the advantages of balanced ultrafiltration and modified ultrafiltration.But the MUF circuit produces an increased diastolic runoff from the aorta that steals flow from the cerebral circulation. It may decrease cerebral blood flow velocities and transcranial mixed venous oxygen saturations.Other possible disadvantages of this system include:(1) the potential for air entrainment at the aortic cannulation site,(2) limitations of flow due to the aortic size,(3) significant arterial to venous shunts,and(4) difficulty in maintaining desired filling pressure,temperature,and blood oxygen saturation.
We think that using a venous-arterial continuous ulrtrafiltration system may avoid these potential disadvantages,and combine the advantages of traditional ultrafiltration mentioned above.So,in this article,the clinical application of venous-arterial ulrtrafiltration system was studied compared with arterial-venous ulrtrafiltration system.To investigate the effect and mechanism of ultrafiltration with different bloodstream derection in attenuating the the main organ edema and injury, and promoting the recovery after operation.There is no similar article reporting. PART1 Contrast study in the clinical application of V-A MUF and A-V MUF after cardiopulmonary bypass in infants
Objective Comparatively study in the clinical application of venous-arterial modified ultrafiltration(V-A MUF) and arterial-venous modified ultrafiltration(A-V MUF) after cardiopulmonary bypass in infants.To evaluate their effects in concentrating blood,excluding harmful inflammatory mediators,shorting operation time,remaining the body temperature and dynamics target of bloodstream stable, preventing and relieving the main organ edema and injury that may follow open heart surgery with cardiopulmonary bypass(CPB).Methods Thirty infants with congenital heart diseases were randomly divided into two groups.In the control group,A-V MUF was used after cardiopulmonary bypass.In the treated group,V-A MUF technique was used after cardiopulmonary bypass.The ultrafiltration time, ultrafiltration speed,body temperature,dynamics target of bloodstream,the serum concentrations of albumin and hematocrit,the serum concentration of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6),static pulmonary compliance (Cstat),airway resistence(Raw),alveolar-arterial oxygen difference(AaDO_2) were measured.Results The ultrafiltration speed was increased,MUF time and operation time was shorted in the treated group compared with the control group,there were statistical difference between the two groups(P＜0.01);In the MUF period,the body temperature and arterial pressure were stable,there were statistical difference between the two groups(P＜0.05);At the 5 minutes,10 minutes after the termination of CPB,the hematocrit and serum albumin concentrations were increased in the treated group compared with the control group,there were statistical difference between the two groups(P＜0.05);At the 20 minutes after the termination of CPB,there were no statistical difference between the two groups(P＞0.05);After MUF,the serum concentration of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6) were all decreased in the two groups,but there were no statistical difference between the two groups(P＞0.05);After MUF,the static pulmonary compliance(Cstat)was increased,airway resistence(Raw) and alveolar-arterial oxygen difference(AaDO_2) were decreased in the treated group compared with the control group(P＜0.05).
Conclusions Compare to the A-V MUF,the clinical application of V-A MUF can effectively short MUF time and operation time,concentrate blood,remain the body temperature and dynamics target of bloodstream stable,attenuate lung edema and injury.
PART2 Contrast study on the influence of ultrafiltration with different bloodstream direction in ultrafiltration time,ultrafiltration speed,body temperature,dynamics target of bloodstream,blood protection,blood concentrating and inflammatory mediators excluding during open heart surgery with cardiopulmonary bypass in infants
Objective Comparatively study on the influence of ultrafiltration with different bloodstream direction in ultrafiltration time,ultra:filtration speed,body temperature, dynamics target of bloodstream,blood protection,blood concentrating and inflammatory mediators excluding during open heart surgery with cardiopulmonary bypass in infants.Methods Thirty patients with congenital heart diseases were randomly divided into two groups.In the control group,balanced ultrafiltration united modified ultrafiltration was used during CPB.In the treated group,venous-medal continuous ultrafiltration was used throughout CPB.The ultrafiltration time, ultrafiltration speed,body temperature,dynamics target of bloodstream,the serum concentration of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6),the serum concentrations of albumin and hematocrit,the plasma levels of D-dimer and free hemoglobin(FHb) were measured.Results The ultrafiltration speed was increased and the ultrafiltration time after CPB was significantly shorted in the treated group compared with the control group(P＜0.01);In the ultrafiltration period after CPB,the body temperature and arterial pressure were stable,there were statistical difference between the two groups(P＜0.05);After ultrafiltration,the serum concentrations of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6) were decreased in the treated group compared with the control group(P＜0.05);At the 5 minutes after after the termination of CPB,the hematocrit and serum albumin concentrations were significantly increased in the treated group compared with the control group(P＜0.01);At the termination of CPB and the 10 minutes after the termination of CPB,the hematocrit and serum albumin concentrations were increased in the treated group compared with the control group(P＜0.05);At the 20 minutes after the termination of CPB,there were no statistical difference between the two groups(P＞0.05);The serum concentrations of free hemoglobin(FHb) in the treated group was lower than that of the control group,there were statistical difference between the two groups(P＜0.05);the plasma levels of D-dimer was lower than that of the control group,but there were no statistical difference between the two groups(P＞0.05).Conclusions Compare to the balanced ultrafiltration united modified ultrafiltration,the clinical application of venous-arterial continuous ultrafiltration throughout CPB can effectively increase the ultrafiltration speed,short the ultrafiltration time after CPB,remain the body temperature and dynamics target of bloodstream after CPB stable,exclude some harmful inflammatory mediators,protect and rapidly concentrate blood.
PART3 Contrast study on the clinical effect of ultrafiltration with different bloodstream direction in protecting the main organ function and promoting the recovery after operation
Objective Comparatively study on the clinical effect of ultrafiltration with different bloodstream direction in protecting the main organ function and promoting the recovery after operation.Methods Thirty patients with congenital heart diseases were randomly divided into two groups.In the control group,balanced ultrafiltration united modified ultrafiltration was used during CPB In the treated group, venous-medal continuous ultra_filtration was used throughout CPB.The serum concentrations of creatine kinase(CK),creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),ejection fraction(EF),heart rates(HR),jugular bulb venous oxygen saturation(SjvO_2),the arteriovenous oxygen difference(AVDO2),static pulmonary compliance(Cstat),airway resistence(Raw),alveolar-arterial oxygen difference(AaDO_2),chest drainage,transfusion of packed red blood cells and fresh frozen plasma,and duration of inotropic support,the mechanical ventilation support time and ICU stay time after operation were measured.Results After CPB,the serum concentrations of CK,CK-MB,and cTnI in the treated group was lower than that of the control group,there were statistical difference between the two groups(P＜0.05);The ejection fraction(EF) was increased,HR was decreased in the treated group compared with the control group,but there were no statistical difference between the two groups(P＞0.05);In the ultrafiltration period afcer CPB,the SjvO_2 was higher and the AVDO_2 was lower than that of the control group,there were statistical difference between the two groups(P＜0.05);The Cstat was increased,the Raw and the AaDO_2 were decreased,in the treated group compared with the control group,there were statistical difference between the two groups(P＜0.05);After operation,the chest drainage,and the transfusion of packed red blood cells and fresh frozen plasma was lower than that of the control group,there were statistical difference between the two groups(P＜0.05);The duration of inotropic support and the mechanical ventilation support time,ICU stay time was shorted in the treated group compared with the control group,there were statistical difference between the two groups(P＜0.05).Conclusions Compare to the balanced ultrafiltration united modified ultrafiltration,the application of venous-arterial continuous ultrafiltration throughout CPB can effectively attenuate the the main organ edema and injury, promote the recovery after operation.
引文
[1]Castaneda AR,Mayer JE,Jonas RA,et al.The neonate with critical congenital heart disease:repair-a surgical challenge[J].J Thorac Cardiovasc Surg,1989,98:869-875.
[2]Kaulitz R,Jux C,Bertram H,et al.Primary repair of tetralogy of Fallot in infancy-the effect on growth of the pulmonary arteries and the risk for late reinterventions[J].Cardiollogy,2001,11(4):391-398.
[3]Toraman F,Evrenkaya S,Yuce M,et al.Highly positive intraoperative fluid balance during cardiac surgery is associated with adverse outcome[J].Perfusion,2004,19(2):85-91.
[4]Lespron Robles M C.Systemic inflammatory response in pediatric cardiac surgery[J].Arch Cardiol Mex,2006,76(12):92-99.
[5]LequierL.Extracorporeal life support in pediatric and neonatal critical care:a review[J].J Intensive Care Med,2004,19(5):243-258.
[6]Magilligan DJ,Chokeno.Ultrafiltration during cardiopulmonary bypass:laboratory evaluation and initial clinical experience[J].Am Thorae Surg,1984,37:33-39.
[7]Osipor VP,LuricGO,Kohodas MY,et al.Hemoconcentration during open heart operations[J].Thorac Cardiovase Surg,1985,33:81-85.
[8]Nayarsu M,Harada Y,Takeuehi T,et al.Initial ultrafiltration to the priming solution with preserved blood for cardiopulmonary bypass in infants[J].Kyobu Geta,1995,48:281-285.
[9]朱德明,王伟,黄惠民,等,超滤在10公斤以下小儿体外循环中的应用[J].中国体外循环杂志,2003,1(3):134-137.
[10]Naik SK,Knight A,Elliott MJ.A prospective randomized study of a modified technique of ultrafiltration during pediatric open heart surgery[J].Circulation,1991,84(supplⅢ):422-431.
[11]Skaryak LA,Kirshbom PM,Bernardo LR,et al.Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest[J].Thorac Cardiovasc Surg,1995,109:744-752.
[12]石广勇,张供,李跃华,等.改良超滤在婴幼儿心内直视手术中的临床应用[J].山东大学学报(医学版),2008,46(6):628-630
[13]Davies MJ,Nguyen K,Gaynor JW,et al.Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass[J].J Thorac Cardiovasc Surg,1998,115:361-369.
[14]Bando K,Vijay P,Turrentine MW,et al.Dilutional and modified ultrafiltration reduces pulmonary hypertension after operations for congenital heart disease:a prospective randomized study[J].J Thorac Cardiovasc Surg,1998,115:517-525.
[15]赵雨辰,杨一峰,朱云,等.改良超滤在低体重婴幼儿(≤10kg)体外循环手术中的应用[J].中国医师杂志,2007,19(9):1236-1237.
[16]Ootaki Y,Yamaguchi M,Oshima Y,et al.Effects of modified ultrafiltration on coagulation factors in pediatric cardiac surgery[J].Surg Today,2002,32(3):203-206.
[17]Fujita M,Ishihara M,Kusama Y,et al.Effect of modified ultrafiltration on inflammatory mediators,coagulation factors,and other proteins in blood after an extracorporeal circuit[J].Artif Organs,2004,28(3):310-313.
[18]龚启华,杨一峰,胡建国,等.改良超滤对婴幼儿心内直视手术后血液流变学的影响[J].中国胸心血管外科临床杂志,2006,13(6):389-392.
[19]Rosendo A,Rodriguez MD,Marc Ruel.High Flow Rates During Modified Ultrafiltration Decrease Cerebral Blood Flow Velocity and Venous Oxygen Saturation in Infants[J].Ann Thorae Surg,2005,80:22-28
[20]黄惠民,姚廷俊,王伟,等,连续性超滤减轻体外循环肺损伤的研究[J].上海医学2003,26(10):742-744
[21]Sever K,Tansel T,Basaran M,et al.The benefits of continuous ultrafiltration in pediatric cardiac surgery.[J]Stand Cardiovasc,2004,38(5):307-311.
[22]Aggarwal N K,Das S N,Sharma G,et al.Efficacy of combined modified and conventional ultrafiltration during cardiac surgery in children[J].Ann Card Anaesth,2007,10(1):27-33.
[23]刘高利,王安彪,李德才,等.平衡超滤联合改良超滤对婴幼儿体外循环术后肺功能的影响[J].中华小儿外科杂志,2006,27(12):625-627.
[24]Skaryak LA,Kirshbom PM,Di Bernardo LR,et al.Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest[J].Thorac Cardiovase Surg,1995,109:744-752.
[25]Hennein HA,Kiziltepe U,Barst S,et al.Venous modified ultrafiltration after cardiopulmonary bypass in children:a prospective randomized study[J].J Thorae Cardiovasc Surg,1999,117:496-505.
[26]李刚,苟大明,杜磊,等.变温式改良超滤改善婴幼儿心脏手术的预后[J].中国体外循环杂志,2008,6(4):193-196.
[27]高岚、王天龙、杨拨贤,等.心脏瓣膜置换术患者体外循环后肺损伤的机制[J].中华麻醉学杂志,2004,24(7):501-503.
[28]Schroeder S,Borger N,Wrigge H,et al.A tumor necrosis factor gene polymorphism influences the inflammatory response after cadiac operation[J].Ann Thorac Surg,2003,75(2):534-537.
[29]Kiely DG,Cargill RI,Struthers AD,et al.Cardiopulmonary effects of endothelin-1 in man[J].Cardiovasc Res,1997,33(2):378-386.
[30]Fujita M,Ishihara M,Kusama Y,et al.Effect of modified ultrafiltration on inflammatory mediators,coagulation factors,and other proteins in blood after an extracorporeal circuit[J].Artif Organs,2004,28(3):310-318.
[31]Maluf MA,Mangia C,Silva C,et al.Conventional and conventional plus modified ultrafiltration during cardiac surgery in high risk congenital heart disease[J].J Cardiovasc Surg,2001,42(4):465-473.
[32]Keenan HT,Thiagarajan R,Stephens KE,et al.Pulmonary function after modified venorenous ultrafiltration in infants:a prospective,randomized trial[J].J Thorac Cardiovasc Surg,2000,119(3):501-507.
[33]刘晋萍,王伟鹏,龙村,等.赴美国哥伦比亚儿童医院参观学习见闻[J].中国体外循环杂志,2007,5(1):63-64.
[34]Battin MR,Penrice J,Gunn TR,et al.Treatment of term infants with head cooling and mild systemic hypothermia after perinatal asphyxia[J].Pediatrics,2003,111(2):244-251.
[35]张鲁英,张广福,姜冠华,等.改良超滤技术在体外循环中的应用[J].中国体外循环杂志,2004,2(1):14-15.
[36]Gunn AJ,Gluckman PD,Gunn TR.Selective head cooling in newborn infants after perinatal asphyxia:a safety study[J].Pediatrics,1998,102(4 Pt1):885-892.
[37]Schmied H,Kurz A,Sessler DI,et al.Mild hypothermia increases blood loss and transfusion requirements during total hiparthroplasty[J].Lancet,1996,347(8997):289-293.
[38]Anttila V,Hagino I,Zurakowski D,et al.Higher bypass temperature correlates with increased white cell activation in the cerebral microcirculation[J].JThorac Cardiovase Surf,2004, 127(6):1781-1788.
[39]Corbett D,Thomhill J.Temperature modulation (hypothermic and hyperthermic conditions) and its influence on histological and behavioral outcomes following cerebral ischemia [J].Brain Patho,2000,10(1):145-152.
[40]Wan S,Desmet JM,Barvais L,et al.Myocardium is a major source of proinflammatory cytokines in patient undergoing cardiopulmonary bypass[J].J Thorac Cardiovasc Surg,1996,112(3):806-811.
[41]Liebold A,Keyl L,Birnbaum DE,et al.The heart produces,but lungs consume proinflammatory cytokines following cardiopulmonary bypass[J].J Cardiothorac Surg,1999,15(3):340-345.
[42]Wan S,Leclerc JI,Schmart ZD,et al.Hepatic release of interleukin-10 during cardiopulmonary bypass in steroid pretreated patients[J].Am Heart J,1997,133(4):335-339.
[43]Hennein HA,Ebba H,Rodriguez JI,et al.Relationship of the proinflammatory cytokines to myocardial ischemia and dysfunction after uncomplicated coronary revascularization[J].J Thorac Cardiovasc Surg,1994,108(1):625-636.
[44]Kawamura T,Znada K,Okada H,et al.Methylprednisolone inhibits increase of interleukin 8 and 6 during open heart surgery[J].Can J Anaesth,1995,42(3):399-403.
[45]Kalfin RE,Engelman RM,Rousou JA,et al.Induction of interleukin-8 expression during cardiopulmonary bypass[J].Circulation,1993,88:401-406.
[46]Furunaga A,Tsuboi H,Iton H,et al.Significance of systemic inflammatory response syndrome at cardiopulmonary bypass[J].Nippon Kyobu Geda Gakkai Zasshi(Japan),1996,44(6):790-794.
[47]Erez E,Erman A,Snir E,et al.Thromboxane production in human lung during cardiopulmonary bypass:beneficial effect of aspirin? [J].Ann Thorac Surg,1998,65(1):101-106.
[48]Menasche P,Peynet J,Ledeist F,et al.Does temperature in extracorporeal circulation affect neutrophil-endothelium in teractions? [J].Arch Mai Coeur Vaiss,1995,88(10):1415-1423.
[49]Seghage MC,Duchateau J,Bruniaux J,et al.Interleukin-10 release related to cardiopulmonary bypass in infants undergoing cardiac operations[J].J Thorac Cardiovasc Surg,1996,111(1):545-553.
[50]Grunenfelder J,Zund G,Schoeberlein A,et al.Modified ultrafiltration lowers adhesion molecule and cytokine levels after cardiopulmonary bypass without clinical relevance in adults[J].J Cardiothorac Surg,2000,17(1):77-83.
[51]Lichtenstein SV,Abel JG,Panos A,et al.Warm heart surgery experience with long cross-clamp times[J].Ann Thorac Surg,1991,52(4):10009-10013.
[52]Qing M,Vazquez-Jimenez JF,Klosterhalfen B,et al.Influence of temperature during cardiopulmonary bypass on leukocyte activation,cytokine balance,and post-operative organ damage[J].Shock,2001,15(5):372-377.
[53]Mann DL.Chapter 12,Congestive Heart Failure.Second Edition,Philadelphia:Lippincott Williams &Wilkins,2000,213-228.
[54]陈亚丽,王士昌,赵维江.充血性心力衰竭患者血清细胞因子变化与肾素血管紧张素系统相关性的研究[J].临床心血管病杂志,2001,17(1):26-27.
[55]钱方毅.重视心力衰竭发病机制中的神经内分泌细胞因子系统的研究[J].中国循环杂志,2001,16(4):243-251.
[56]傅广,赵水平.心力衰竭患者TNF-α和IL-6的变化及氯沙坦的影响[J]..中国循环杂志,2001,16(4):243-245.
[57]Bozkurt B,Kribbs SB,Clubb F,et al.Pathophysiologically relevant concentrations of tumor necrosis factor alpha promote progressive left ventricular dysfunction and remodeling in rats[J].Circulation,1998,97:1382-1391.
[58]Ichijo H,Nishida E,Irie K,et al.Induction of apoptosis by ASK1,a mammalian MAPKKK that activates SAPK/JNK and P38 signaling pathways[J].Science,1997,275:90-94.
[59]Asimakopoulos G.Mechanisms of the systemic inflammatory response[J].Perfusion,1999,14(4):269-277.
[60]Defoe GR,Ross CS,Olmstead EM,et al.Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass graffing.Northern New England Cardiovascular Disease Study GrouP[J].Ann Thorac Surg,2001,71:769-776
[61]Fang WC,Helm RE,Krieger KH,et al.Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery[J].Circulation,1997,96(Suppl.Ⅱ):194-199
[62]Swaminathan M,Phillips-Bute BG,Conlon PJ,et al.The association of lowest hematocrit during Cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery [J].Ann Thorac Surg,2003,76:784-791
[63]KazmiW H,Kausz AT,Khan S,Anemia:an early complication of chronic renal insufficiency [J].Am J Kidney Dis,2001,38:803-812.
[64]Nollert G,Sperling J,SakamotoT,et al.Higher hematocrit improves liver blood flow and metabolism during cardiopulmonary bypass in piglets[J].Thorac Cardiov Surg,2001,49:226-230.
[65]郑理玲.新型低预充体外循环装置在心脏外科手术中应用的系列研究:[博士学位论文].福建:福建医科大学,2004.
[66]Giomarelli P,Sabino S,Borrelli E,et al.Myocardial and lung injury after cardiopulmonary bypass:role of interleuldn(IL)-10[J].Ann Thorac Surg,2003,76(1):117-123.
[67]McBride WT,Allen S,Gornley SM,et al.Methylprednisolone favourably alters plasma and urinary cytokine homeostasis and subclinical renal injury at cardiac surgery[J].Cytokine,2004,27(2-3):81-89.
[68]Brouicki RA,Backer CL,Baden HP,et al.Dexamethosone reduce the inflammatory response to cardiopulmonary bypass in children[J].Ann Thorac Surg,2000,69(5):1490-1495.
[69]Bach F,Grundmann U,Bauer M,et al.Modulation of the inflammatory response to cardiopulmonary bypass by dopexamine and epidural anesthesia[J].Acta Anaesthesiol Scand,2002,46(10):1227-1235.
[70]Tayama E,Hayashida N,Fukunaga S,et al.High-dose cimetidine reduces proinflammatory reaction after cardiac surgery with cardiopulmonary bypass[J].Ann Thorac Surg,2001,72(6):1945-1949.
[71]Brull DJ,Sanders J,Rumley A,et al.Impact of angiotensin converting enzyme inhibition on post-coronary artery bypass interleukin-6 release[J].Heart,2002,87(3):252-255.
[72]徐康清,孙培吾,黄文起,等.乌司他丁对体外循环心脏手术后肺功能的影响[J].中华胸心血管外科杂志,2004,20(1):7-9.
[73]Li D,Zhao L,Liu M,et al.Kineties of tumor necrosis factor alpha in plasma and the cardioprotective effect of a monoclonal antibody to tumor necrosis factor alpha in acute myocardial infarction[J].Am Heart J,1999,137(6):1145-1152.
[74]Fitch JC,Rollins S,Matis L,et al.Pharmacology and biological efficacy of a recombinant, humanized,single-chain antibody C_5 complement inhibitor in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass[J].Circulation,1999,100(25):2499-2506.
[75]Mojcik CF,Levy JH.Aoprotinin and the systemic inflammatory response after cardiopulmonary bypasss[J].Ann ThoracSurg,2001,71(2):745-754.
[76]Hill GE,Alonso A,Spurzem JR,et al.Aprotinin and methylprednisolone equally blunt cardiopulmonary bypass induced inflammatory reaction in humans[J].J Thorac Cardiovasc Surg,1995,110(5):1658-1662.
[77]PalluaN,Low JF,Heimburg D.Pathogenic role of interleukin-6 in the development of sepsis.Part Ⅱ:Significance of anti-interleukin-6 and anti-soluble interleukin-6 receptor-alpha antibodies in a standardizedmurine contactburn model[J].Crit Care Med,2003,31(5):1495-1501.
[78]辛惠霞,王心田.抑肽酶致过敏性休克82例回顾性分析[J].中国药房,2005,16(8):616-617.
[79]Mangano DT,Miao Y,Vuylsteke A,et al.Investigators of The Multicenter Study of Perioperative Ischemia Research Group;Ischemia Research and Education Foundation[J].JAMA,2007,297(5):471-479.
[80]Richter JA,Meisner H,Tassani P,et al.Drew-Anderson technique attenuates systemic inflammatory response syndrome and improves respiratory function after coronary artery bypass grafting[J].Ann Thorac Surg,2000,69(1):77-83.
[81]Palatianos GM,Balentine G,Papadakis EG,et al.Neutrophil depletion reduces myocardial reperfusion morbidity[J].Ann Thorac Surg,2004,77(3):956-961
[82]Karaiskos TE,Palatianos GM,Triantafillou CD,et al.Clinical effectiveness of Leukocyte filtration during cardiopulmonary bypass in patients with chronic obstructive pulmonary disease[J].Ann ThoracSurg,2004,78(4):1339-1344.
[83]Grossi EA,Kallenbach K,Chau S,et al.Impact of heparin bonding on pediatric cardiopulmonary bypass:a prospective randomized study[J].Ann Thorac Surg,2000,70(1):191-196.
[84]Jensen E,Andreasson S,Bengtsson A,et al.Influence of two different perfusion systems on inflammatory response in pediatric heart surgery[J].Ann Thorac Surg,2003,75(3):919-925.
[85]Harig F,FeyrerR,Mahmoud FO,et al.Reducing the post-pump syndrome by using heparincoated circuits,steroids,oraprotinin[J].Thorac Cardiovasc Surg,1999,47(2):111-118.
[86]Harig F,Hohenstein B,Vonder J,et al.Modulating IL-6 and IL-10 levels by pharmacologic strategies and the impact of different cardiopulmonary bypass parameters during cardiac surgery[J].Shock,2001,16 Suppll:33-38.
[87]InuiK,ShimazakiY,WatanadeT,et al.Effects of duraflo Ⅱ heparin-coated cardiopulmonary bypass circuits on the coagulalon system,endothelial damage,and cytokine release in patients with cardiac operation employing aprotinin and steroids[J].Artif Organs,1999,23(12):1107-1112.
[88]Naik SK,Elliott MJ.Ultrafiltration and pediatric cardiopulmonary bypass[J].Perfusion,1993,8:101-112.
[89]Yuiehiron N,Mneteka M,Yoshihro T,et al.Conparative study of cell saver and ultrafiltration nontransfusion in cardiac surgery[J].Ann Thorac Surg,1990,49:973-978.
[90]Naik SK,Balaji S,Elliott M.Modified ultrafiltration improves hemnodynamics after cardiopullnonary bypass in children[J].JACC,1992,19:37.
[91]吴华.不同膜平衡超滤影响体外循环炎症反应的临床研究:[博士学位论文].广州:第一军医大学,2004.
[92]Williams GD,Ramamoorthy C.The routine use of aproyinin during pediatric cardiac surgery is not a benefit[J].J Cardiothrac and Vase Anesth,1999,13:785-790.
[93]Jouronis D,Puopard P,Greeley WJ,et al.Hemofiltration during cardiopulmonary bypass in pediatric cardiac surgery[J].Anesthesiol,1994,81:1181-1189.
[94]Journois D,Israel-Biet D,Pouard P,et al.High volume,zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children[J].Anesthesiology,1996,86:965-976.
[95]田步升,李国荣,崔爱玲,等.负压对机械转流管道中血流溶血过程的影响[J].中华物理医学与康复杂志,2000,22(3):181-182.
[96]段大为,陈德凤,王晓莉,等.体外循环过程中引起血红蛋白尿的原因分析[J].生物医学工程与临床,2000,4(2)101-104.
[97]万彩虹,董培青,杨璟,等.体外循环对红细胞流变学特性和形态的影响[J].中国体外循环杂志,2003,1(4):216-218.
[98]Holloway DS,Summaria L,Sandesara J,et al.Decreased platelet number and function and increased fibrinolysis contribute to post-operative bleeding in cardiopulmonary bypass patients[J].Thromb Haemost,1988,59(1):62.
[99]Kayuthof M.Inhibition of platelet adhesion during cardiopulmonary bypass reduces postoperative bleeding[J].Circulation,1994,90(1):269-274.
[100]Hard JF,Belisle S.Natural and synthetic antifibrinolytics in adult cardiac surgery:efficacy,effectiveness and efficiency[J].Can J Anesth,1994,41(11):1104-1112.
[101]王庆善,张荣振,许大庆,等.体外循环期间D-二聚体的变化[J].中华胸心外科杂志,1998,14(1):5-6.
[102]马乐龙,刘平波,高纪平,等.7公斤以下婴幼儿先天性心脏病根治术[J].临床小儿外科杂志,2006,5(1):20-22.
[103]Mangano DT.Beyond CK-MB biochemical markers for perioperative myocardial infarction [J].Anesthesiology,1994,81:1317-1320.
[104]Eigel P,Van Ingen G,Wagenpfeil S.Predictive value of perioperative cardiac troponin I for adverse outcom in coronary artery bypass surgery[J].Eur J Cardiothorac Surg,2001,20:544-549.
[105]Nahum N,Zisman E,Wolf T,et al.Strict thermo regulation attenuates myocardial injury during coronary artery bypass graftsurgery as reflected by reduced levels of cardiac-specific troponin I[J].Anesth Analg,2003,96:328-335.
[106]范丹,谢东篱,谢先丰,等.体温调节在先天性心脏病患儿手术中对心肌酶的影响[J].临床麻醉学杂志,2008,24(6):465-467.
[107]薛富善,赵俊.体温与麻醉[J].临床麻醉学杂志,1992,8:180-183.
[108]Frank SM,Fleisher LA,Breslow MJ,et al.Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events.A randomized clinical trial[J].JAMA,1997,277:1127-1129
[109]Nollert G,Reichart B.Cardiopulmonary bypass and cerebral injury in adults[J].Shock,2001,16(Suppl Ⅰ):16-19.
[110]Schell RM,Kem FH,Greeley WJ,et al.Cerebral blood flow and metabolism during cardiopulmonary bypass[J].Anesth Analg,1993,76(4):849-865.
[111]Aoki-S.The evaluation of cerebral oxygen balance during moderate hypothermic cardiopulmonary bypass[J].Masui,1995,44(l 1):1520-1526.
[112]Enomoto S,Hindman BJ,DeXter F,et al.Rapid rewarming causes an increase in the cerebral metabolic rate for oxygen that is temporarily unmatched by cerebral blood flow[J].Anesthesiology,1996,84(6):1392-1400.
[113]Croughwell ND,Fraseo P,Blumefthal JA,et al.warming during cardiopulmonary bypass is associated with jugular bulb desaturation[J].AnnThoracsurg,1992,52:827-832.
[114]Nakajima T,Kuro M,Hayashi Y,et al.Clinical evaluation of cerebral oxygen balance during cardiopulmonary bypass:on-line continuous monitoring of jugular venous oxyhemoglobin saturation[J].Anesth Analg,1992,74(5):630-635.
[115]Dearden NM.Jugular bulb venous oxygen saturation in the management of severe head injury[J].Curr Opin Anesthesiol,1991,4:279-286.
[116]Kadoi Y,Saito S,Takahashi K.Jugular venous oxygen saturation during mild hypothermic versus normothermic cardiopulmonary bypass in elderly patients[J].Surg Today,2004,34(5):399-404.
[117]Hindman BJ,Todd MM.Gelb AW et al.Mild hypothermia as a protective therapy during intracranial aneurysm surgery:a randomized prospective pilot trial[J].Neurosurgery,1999:44:23-32
[118]Jansen GF,Wan Praagh BH,Kedaria MB,et al.Jugular bulb oxygen saturation during propofol and isoflurane/nitrous oxide anesthesia in patients undergoing brain tumor surgery [J].Anesth Analg.,1999,89(2):358-363.
[119]Braekken SK,Russell D,Brucher R,et al.Cerebral microembolic signals during cardiopulmonary bypass surgery.frequency,time of occurrence,and association with patient and surgical characteristics[J].Stroke,1997,28(10):1988-1992.
[120]Pugsley W,Klinger L.Pasehalis C,et al.The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning [J].Stroke,1994,25:1393-1399.
[121]Sylivris S,Levi C,Matalanis G,et al.Patten and significance of cerebral mieroemboli during coronary artery bypass grafting[J].Ann Thorac Surg,1998,66:1674-1678.
[122]Brown WR,Moody DM,ChallaVR,et al.Longer duration of cardiopulmonary bypass is associated with greater numbers of cerebral microemboli [J].Stroke,2000,31:707-713.
[123]Taggart DP.Bhattacharya K,Meston N,et al.Serum S-100 protein concentration after cardiac surgery:a randomized trial of arterial line filtration[J].Eur J Cardiothorac Surg,1997,11(4):645-649.
[124]Brooker RF,Brown WR,Moody DM.et al.Cardiotomy suction:a major source of brain lipid emboli during cardiopulmonary bypass[J].Ann Thorac Surg,1998,65:1651-1655.
[125]Nandate K,Vuylsteke A,Crosbie AE,et al.Cerebrovascular cytokine responses during coronary artery bypass surgery:specific production of interleukin-8 and its attenuation by hypothermic cardiopulmonary bypass[J].Anesth Analg,1999,89:823-828.
[126]Wan S,Desnet JM,Barvais L,et al.Myocardium is a major source of inflammatory cytokines in patients undergoing cardiopulmonary bypass[J].Thorac Cardiovasc Surg,1996,112:806-811.
[127]Kawamura T,Wakusawa R,Okada K,et al.Elevation of cytokines during open heart surgery with cardiopulmonary bypass:Participant of interleukin-8 and 6 in reperfusion injury [J].Can J Anaesth,1993,40:1016-1022.
[128]Ashraf SS,Tian Y,Zacharrias S,et al.Effeets of cardiopulmonary bypass on neonatal and pediatric inflammatory profiles[J].Eur J Cardiothorac Surg,1997,12(6):862-868.
[129]Robertson CS,Narayan RK,Gokaslan ZL,et al.Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients[J].J Neuro surg,1989,70(2):222-230.
[130]Gopinath SP,Cormio M,Ziegler J,et al.Intraoperative jugular desaturation during sugery for traumatic iniracranial hematomas[J].Anesth Analg,1996,83(5):1014-1021.
[131]Perez A.Minces PG,Sehnitzler EJ,etal.Jugular venous oxygen saturationor arteriovenous difference of lactate content and outcome in children with severe traumatic brain injury [J].Pediatr Crit Care Med,2003,4(1):33-38.
[132]Reinert M,Alessandri B.Seiler R,et al.Influence of inspired oxygen on glucose-lactate dynamics after subdural hematoma in the rat[J].Neurol Res,2002,24(6):601-606.
[133]Ng CS.Wang S,Yim AP,et a.l Pulmonary dysfunction after cardiac surgery[J].Chest,2002,121(4):1269-1277.
[134]SieversH,Freand K,Eleftheriadis S,et al.Lung protection during total cardiopulmonary bypass by isolated lung perfusion:result so fanovel perfusions trategy[J].Ann Thorac, 2003,76(2):516-521.
[135]Chai PJ,Williamson JA,Lodge AJ,et al.Effects of ischemia on pulmonary dysfunction after cardiopulmonary bypass[J].Ann Thorac Surg,1999,67(3):731-735.
[136]Jansen PG,Velthuis H,Huybregts RA,et al.Reduced complement activation and improved postoperative performance after cardiopulmonary bypass with heparin-coated circuitsl [J].J Thorac Cardiovasc Surg,1995,110(3):829-841.
[137]de Mendonca-Filho HT.Gomes RV,de Almeida Campos LA.et al.Circulating levels of macrophagemigration inhibitory factor are associated with mild pulmonary dysfunction after cardiopulmonary bypass [J].Shock,2004,22(6):533-537.
[138]Giomarelli P,Scolletta S,Borrelli E,et al.Myocardialand lung injury after cardiopulmonary bypass:role of interleukin(IL)-10 [J].Ann Thorac Surg,2003,76(1):117-123.
[139]Rinder CS,Rinder HM,Smith MJ,et al.Antithrombin reduces monocyte and neutrophil CD11b up regulation in addition to blocking platelet activation during extracorporeal circulation[J].Transfusion,2006,46(7):1130-1137.
[140]Kovesi T,Szabo A,Royston D,et al.Correlation between pulmonary gas exchange and basal and nitroglycerin-induced exhaled nitric oxide in patients undergoing cardiac surgery [J].Vascul Pharmacol,2005,43(6):434-440.
[141]Schlensak C,Doenst T,Preusser S,et al.Cardiopulmonary bypass reduction of bronchial blood flow:a potential mechanism for lung injury in a neonatal pig model [J].J Thorac Cardiovasc Surg,2002,123(6):1199-1205.
[142]Suzuki T,Fukuda T.Continuous pulmonary perfusion during cardiopulmonary bypass prevents lung injury in infants [J].Ann Thorac Surg,2000,69(2):602-606.
[143]Babik B,Asztalos T,Petak F,et al.Changes in respiratory mechanics during cardiac surgery[J].Anesth Analg,2003,96(5):1280-1287.
[144]Schultz JM.Karamlou T,Swanson J,et al.Hypothermic low-flow cardiopulmonary bypass impairspulmonary and right ventricular function more than circulatory arrest[J].AnnThorac Surg,2006,81(2):474-80.
[1]Toraman F,Evrenkaya S,Yuce M,et al.Highly positive intraoperative fluid balance during cardiac surgery is associated with adverse outcome[J].Perfusion,2004,19(2):85-91.
[2]Lespron Robles M C.Systemic inflammatory response in pediatric cardiac surgery[J].Arch Cardiol Mex,2006,76(12):92-99.
[3]LequierL.Extracorporeal life support in pediatric and neonatal critical care:a review[J].J Intensive Care Med,2004,19(5):243-258.
[4]Naik SK,Elliott MJ.Ultrafiltration and pediatric cardiopulmonary bypass[J].Perfusion,1993,8:101-112.
[5]Adam D,Surem N,NigelK,et al.Interleukin-8 release and neutrophilde granulation after pediatric cardiopulmonary bypass[J].Thorca Cardiovasc Surg,1993,105:234-241.
[6]Wan S,Desmet JM,Barvais L,et al.Myocardium is a major source of proinflammatory cytokines in patient undergoing cardiopulmonary bypass[J].J Thorac Cardiovasc Surg,1996,112(3):806-811.
[7]Rinder CS,FontesM,Mathew JP,et al.Neutrophil CD11b up regulation during cardiopulmonary bypass is associated with postoperative renal injury[J].AnnThorac Surg,2003,75(3):899-905.
[8]Massoudy P,Zahler S,Becker BF,et al.Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with cardiopulmonary bypass[J].Chest,2001,119(1):31-36.
[9]Antonelli M,Testa G,Tritapepe L,et al.IL-8,IL-6 and ICAM-1 in serum of pediatric patients undergoing cardiopulmonary bypass with and without cardiocirculatory arrest[J].J Cardiovasc Surg(Torino),1999,40(6):803-809.
[10]Aebert H,Kirchner S,Keyser A,et al.Endothelial apoptosis is induced by serum of patients after cardiopulmonary bypass[J].Eta JCardiothorac Surg,2000,18(5):589-593
[11]Elliot MJ.Ultraflltration and modified ultrafiltration in pediatric open heart operations[J].Ann Thorac Stag,1993,65:1518-1522.
[12]Milllar AB,Armstong L,Linderetal.Cytokine production and hemofiltration in children undergoing cardiopulmonary bypass[J].Am Thorac Stag,1993,56:1499-1502.
[13]Defoe GR,Ross CS,Olmstead EM,et al.Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass graffing.Northern New England Cardiovascular Disease Study Group[J].Ann Thorac Surg,2001,71:769-776.
[14]Fang WC,Helm RE,Krieger KH,et al.Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery[J].Circulation,1997,96(Suppl.Ⅱ):194-199.
[15]Swaminathan M,Phillips-Bute BG,Conlon PJ,et al.The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery[J].Ann Thorac Surg,2003,76:784-791.
[16]Kazmi WH,Kausz AT,Khan S.Anemia:an early complication of chronic renal insufficiency[J].Am J Kidney Dis,2001,38:803-812.
[17]Nollert G,Sperling J,SakamotoT,et al.Higher hematocrit improves liver blood flow and metabolism during cardiopulmonary bypass in piglets[J].Thorae Cardiov Surg,2001,49:226-230.
[18]郑理玲.新型低预充体外循环装置在心脏外科手术中应用的系列研究:[博士学位论文].福建:福建医科大学,2004.
[19]薛富善,赵俊.体温与麻醉[J].临床麻醉学杂志,1992,8:180-183.
[20]Frank SM,Fleisher LA,Breslow MJ,et al.Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events.A randomized clinical trial[J].JAMA,1997,277:1127-1129.
[21]范丹,谢东篱,谢先丰,等。体温调节在先天性心脏病患儿手术中对心肌酶的影响[J]. 临床麻醉学杂志,2008,24(6):465-467.
[22]Magilligan DJ,Chokeno.UltrafiItration during cardiopulmonary bypass:laboratory evaluation and initial clinical exprience[J].Am Thorae Surg,1984,37:33-39.
[23]Osipor VP,Luric GO,Kohodas MY,et al.Hemoconcentration during open heart operations [J].Thorac Cardiovase Surg,1985,33:81-85.
[24]Darling EM,Shearer R,Katharine N et al.Modified ultrafiItration in pediatric cardiopulmonary bypass[J].J Extra Corppor Tech,1994,26:205-209.
[25]Stark J著.朱晓东主译.先天性心脏病外科学[M].北京:人民卫生出版社,1996,136-150.
[26]Rabinoriteh M.Problems of pulmonary hypertension in children with congenital heart disease [J].Chest,1998,93:1195.
[27]吉冰洋.体外循环后肺损伤和急性呼吸窘迫综合征[J].心血管病学进展,2002,23(3):158-160.
[28]Sehlensak C,Doenst T,Preusser S,et al.Cardiopulmonary bypass reduction of bronchial blood flow:a potential mechanism for lung injury in a neonatal pig model[J].J Thorac Cardiovase Surg,2002,123(6):1199-1205.
[29]Suzuki T,Fukuda T.Continuous pulmonary perfusion during cardiopulmonary bypass prevents lung injury in infants[J].Ann Thorac Surg,2000,69(2):602-606.
[30]陈亚丽,王士昌,赵维江.充血性心力衰竭患者血清细胞因子变化与肾素血管紧张素系统相关性的研究[J].临床心血管病杂志,2001,17(1):26-27.
[31]钱方毅.重视心力衰竭发病机制中的神经内分泌细胞因子系统的研究[J].中国循环杂志,2001,16(4):243-251.
[32]傅广,赵水平.心力衰竭患者TNF-α和IL-6的变化及氯沙坦的影响[J].中国循环杂志,2001,16(4):243-245.
[33]Hennein HA,Ebba H,Rodriguez JI,et al.Relationship of the proinflammatory cytokines to myocardialischemia and dysfunction after uncomplicated coronary revascularization[J].JThorac Cardiovasc Surg,1994,108(1):625-636.
[34]Zkurt B,Kribbs SB,Clubb F,et al.Pathophysiologically relevant concentrations of tumor necrosis factor-alpha promote progressive left ventricular dysfunction and remodeling in rats[J].Circulation,1998,97:1382-1391.
[35]Ichijo H,Nishida E,Irie K,et al.Induction of apoptosis by ASK1,amammalian MAPKKK that activates SAPK/JNK and P38 sigaling patllways [J].Science,1997,275:90-94.
[36]Nollert G.Reichart B.Cardiopulmonary bypass and cerebral injury inadults[J].Shock.,2001,16(SupplⅠ):16-19.
[37]Schell RM,Kem FH,Greeley WJ,et al.Cerebral blood flow and metabolism during cardiopulmonary bypass[J].Anesth Analg,1993,76(4):849-865.
[38]Aoki-S.The evaluation of cerebral oxygen balance during moderate hypothermic cardiopulmonary bypass[J].Masui,1995,44(11):1520-1526.
[39]Enomoto S,Hindman BJ.DeXter F,et al.Rapid rewarming causes an increase in the cerebral metabolic rate for oxygen that is temporarily unmatched by cerebral blood flow[J].Anesthesiology,1996,84(6):1392-1400.
[40]Croughwell ND,Fraseo P.Blumefthal JA.et al.warming during cardiopulmonary bypass is associated with jugular bulb desaturation[J].AnnThoracsurg,1992,52:827-832.
[41]Nakaj ima T,Kuro M,Hayashi Y,et al.Clinical evaluation of cerebral oxygen balance during cardiopulmonary bypass:on-line continuous monitoring of jugular venous oxyhemoglobin saturation[J].AnesthAnalg,1992,74(5):630-635.
[42]Dearden NMJugular bulb venous oxygen saturation in the management of severe head injury[J].Curr Opin Anesthesiol,1991,4:279-286.
[43]Kadoi Y,Saito S,Takahashi K.Jugular venous oxygen saturation during mild hypothermic versus normothermic cardiopulmonary bypass in elderly patients[J].Surg Today,2004,34(5):399-404.
[44]Hindman BJ.Todd MM.Gelb AW et al.Mild hypothermia as a protective therapy during Intracranial aneurysm surgery:a randomized prospective pilot trial[J].Neurosurgery,1999,44:23-32
[45]Jansen GF.Wan Praagh BH,Kedaria MB.et al.Jugular bulb oxygen saturation during propofol and isoflurane/nitrous oxide anesthesia in patients undergoing brain tumor surgery[J].Anesth Analg,1999,89(2):358-363.
[46]Braekken SK,Russell D,Brucher R,et al.Cerebral microembolic signals during cardiopulmonary bypass surgery.frequency,time of occurrence,and association with patient and surgical characteristics[J].Stroke,1997,28(10):1988-1992.
[47]Pugsley W,Klinger L,Pasehalis C.et al.The impact of microemboli during cardiopulmonary bypass on neuropsyehological functioning[J].Stroke,1994,25:1393-1399.
[48]Sylivris S,Levi C,Matalanis G,et al.Patten and significance of cerebral mieroemboli during Coronary artery bypass grafting[J].Ann Thorac Surg,1998,66:1674-1678.
[49]Brown WR,Moody DM.ChallaVR,etal.Longer duration of cardiopulmonary bypass is associated with greater numbers of cerebral microemboli[J].Stroke,2G00,31:707-713.
[50]Taggart DP,Bhattacharya K,Meston N,et al.Serum S-100 protein concentration after cardiac surgery:a randomized trial of arterial line filtration[J].Eur J Cardio thorac Surg,1997,11(4):645-649.
[51]Brooker RF,Brown WR,Moody DM,et al.Cardiotomy suction:a major source of brain lipid emboli during cardiopulmonary bypass[J].Ann Thorac Surg,1998,65:1651-1655.
[52]Nandate K,Vuylsteke A,Crosbie AE,et al.Cerebrovascular cytokine responses during coronary artery bypass surgery:specific production of interleukin-8 and its attenuation by hypothermic cardiopulmonary bypass[J].Anesth Analg,1999,89:823-828.
[53]Wan S,DeSnet JM,Barvais L,et al.Myocardium is a major source of inflammatory cytokines in patients undergoing cardiopulmonary bypass[J].Thorac Cardiovasc Surg,1996,112:806-811.
[54]Kawamura T,Wakusawa R,Okada K,et al.Elevation of cytokines during open heart surgery with cardiopulmonary bypass:Participant of interleukin-8 and 6 in reperfusion injury[J].Can J Anaesth,1993,40:1016-1022.
[55]Ashraf SS,Tian Y,Zacharrias S,et al.Effeets of cardiopulmonary bypass on neonatal and pediatric inflammatory profiles[J].Eur J Cardiothorac Surg,1997,12(6):862-868.
[56]Fleming F,Bohn D,Edwards.Renal replacement therapy after repair of congenital heart disease in children acomprason of hemofiltration and peritoneal dialysis[J].Thorac Cardiovasc Surg,1995,109(2):322-331.
[57]Suen WS,Mok CK,Chiu SW,et al.Risk factors for development of acute renal failure(ARF)requiring dialysis in patients undergoing cardiac surgery[J].Angiolgy,1998,49(10):789-800.
[58]ManganoCM,Diamondstone LS,Ramsay JQ,et al.Renal dysfunction after myocardial revascularization:risk factors,adverse outcomes,and hospital resource utilization.The Multi Center Study of Perioperative Isehemia Research Group[J].Ann Intern Med,1998,128(3):194-203.
[59]Meldrum DR,Donnalloo KK.Role of TNF in mediating renal in sufficiency following cardiac surgery:evidence of a post bypass cardio renal syndrome[J]Surg Res,1999,85(2):185-199.
[60]Zanardo G,Miehielon P,Paecagnella A,et al.Acute renal failure in the patient undergoing cardiac operation,prevalence,mortality rate,and main risk faetors[J].Thorac Cardiovasc Surg,1994,107(6):1489-1495.
[61]Shahzad G.Raja.The 'dark side' of cardiopulmonary bypass[J].European Journal of Cardiothoracic Surgery,2004,25:905-907.
[62]Wehlin L,Vedin J,Vaage J,et al.Activation of complement and leukocyte receptors during on- and off pump coronary artery bypass surgery[J].Eur J Cardiothorac Surgery,2004,25:35-42.
[63]Giomarelli P,Sabino S,Borrelli E,et al.Myocardial and lung injury after cardiopulmonary bypass:role of interleukin(IL)-10[J].Ann Thorac Surg,2003,76(1):117-123.
[64]McBride WT,Allen S,Gornley SM,et al.Methylprednisolone favourably alters plasma and urinary cytokine homeostasis and subclinical renal injury at cardiac surgery[J].Cytokine,2004,27(2-3):81-89.
[65]Brouicki RA,Backer CL,Baden HP,et al.Dexamethosone reduce the inflammatory response to cardiopulmonary bypass in children[J].Ann Thorac Surg,2000,69(5):1490-1495.
[66]Bach F,Grundmann U,Bauer M,et al.Modulation of the inflammatory response to cardiopulmonary bypass by dopexamine and epidural anesthesia[J].Acta Anaesthesiol Scand,2002,46(10):1227-1235.
[67]Tayama E,Hayashida N,Fukunaga S,et al.High-dose cimetidine reduces proinflammatory reaction after cardiac surgery with cardiopulmonary bypass[J].Ann Thorac Surg,2001,72(6):1945-1949.
[68]Brull DJ,Sanders J,Rumley A,et al.Impact of angiotensin converting enzyme inhibition on post-coronary artery bypass interleukin 6 release[J].Heart,2002,87(3):252-255.
[69]Pallua N,Low JF,Heimburg D.Pathogenic role of interleukin-6 in the development of sepsis.Part Ⅱ:Significance of anti-interleukin-6 and anti-soluble interleukin-6 receptor-alpha antibodies in a standardized mudne contact burn model[J].Crit Care Med,2003,31(5):1495-1501.
[70]Li D,Zhao L,Liu M,et al.Kinetics of tumor necrosis factor alpha in plasma and the cardioprotective effect of a monoclonal antibody to tumor necrosis factor alpha in acute myocardial infarction[J].Am Heart J,1999,137(6):1145-1152.
[71]Fitch JC,Rollins S,Matis L,et al.Pharmacology and biological efficacy of a recombinant,humanized,single-chain antibody C_5 complement inhibitor in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass[J].Circulation,1999,100(25):2499-2506.
[72]徐康清,孙培吾,黄文起,等.乌司他丁对体外循环心脏手术后肺功能的影响[J].中华胸心血管外科杂志,2004,20(1):7-9.
[73]Mojcik CF,Levy JH.Aoprotinin and the systemic inflammatory response after cardiopulmonary bypasss[J].Ann Thorac Surg,2001,71(2):745-754.
[74]Hill GE,Alonso A,Spurzem JR,et al.Aprotinin and methylprednisolone equally blunt cardiopulmonary bypass induced inflammatory reaction in humans[J].J Thorac Cardiovasc Surg,1995,110(5):1658-1662.
[75]辛惠霞,王心田.抑肽酶致过敏性休克82例回顾性分析[J].中国药房,2005,16(8):616-617.
[76]Mangano DT,Miao Y,Vuylsteke A,et al.Investigators of The Multicenter Study of Perioperative Ischemia Research Group;Ischemia Research and Education Foundation[J].JAMA,2007(5):471-479.
[77]Richter JA,Meisner H,Tassani P,et al.Drew-Anderson technique attenuates systemic inflammatory response syndrome and improve s respiratory function after coronary artery bypass grafting[J].AnnThoracSurg,2000,69(1):77-83.
[78]Palatianos GM,Balentine G,Papadakis EG,et al.Neutrophil depletion reduces myocardial reperfusionmorbidity[J].Ann Thorac Surg,2004,77(3):956-961
[79]Karaiskos TE,Palatianos GM,Triantafillou CD,et al.Clinical effectiveness of Leukocyte filtration during cardiopulmonary bypass in patients with chronic obstructive pulmonary disease[J].Ann Thorac Surg,2004,78(4):1339-1344.
[80]Grossi EA,Kallenbach K,Chau S,et al.Impact of heparin bonding on pediatric cardiopulmonary bypass:a prospective randomized study[J].Ann Thorac Surg,2000,70(1):191-196.
[81]Jensen E,Andreasson S,Bengtsson A,et al.Influence of two different perfusion systems on inflammatory response in pediatric heart surgery[J].Ann Thorac Surg,2003,75(3):919-925.
[82]Harig F,FeyrerR,Mahmoud FO,et al.Reducing the post-pump syndrome by using heparincoated circuits,steroids,or aprotinin[J].Thorac Cardiovasc Surg,1999,47(2):111-118.
[83]Harig F,Hohenstein B,Vender J,et al.Modulating IL-6 and IL-10 levels by pharmacologic strategies and the impact of different cardiopuhnonary bypass parameters during cardiac surgery[J].Shock,2001,16 Suppl1:33-38.
[84]Inui K,Shimazaki Y,Watanade T,et al.Effects of Duraflo Ⅱ heparin-coated cardiopulmonary bypass circuits on the coagulaion system,endothelial damage,and cytokine release in patients with cardiac operation employing aprotinin and steroids[J].Artif Organs,1999,23(12):1107-1112.
[85]Yuiehiron N,Mneteka M,Yoshihro T,et al.Comparative study of cell saver and ultrafiltration nontransfusion in cardiac surgery[J].Ann Thorac Surg,1990,49:973-978.
[86]Nayarsu M,Harada Y,Takeuehi T,et al.Initial ultrafiltration to the priming solution with preserved blood for cardiopulmonary bypass in infants[J].Kyobu Geta,1995,48:281-285.
[87]吴华.不同膜平衡超滤影响体外循环炎症反应的临床研究:[博士学位论文].广州:第一军医大学,2004.
[88]Williams GD,Ramamoorthy C.The routine use of aproyinin during pediatric cardiac surgery is not a benefit[J].J cardiothrac and Vase.Anesth,1999,13:785-790.
[89]Jouronis D,Puopard P,Greeley WJ,et al.Hemofiltration during cardiopulmonary bypass in pediatric cardiac surgery[J].Anesthesiol,1994,81:1181-1189.
[90]Naik SK,Knight A,Elliontt MJ.A prospective randomized study of a modified technique of ultrafiltration during pediatric open heart surgery[J].Circulation,1991,84(SupplⅢ):422-431.
[91]Boldt J,Kling D,Bormann BV,et al.Extravascular lung water and hemofiltration during complicated cardiac surgery[J].Thorac Cardiovase Surg,1987,35:161-165.
[92]Skaryak LA,Kirshbom PM,Di Bernardo LR,et al.Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest[J].Thorac Cardiovasc Surg,1995,109:744-752.
[93]Journois D,Israel-Biet D,Pouard P,et al.High volume,zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children[J].Anesthesiology, 1996,86:965-976.
[94]Naik SK,Knight A,Elliott MJ.A successful modification of ultrafiltration for cardiopulmonary bypass in children[J].Perfusion,1991,6:41-50.
[95]石广勇,张供,李跃华,等.改良超滤在婴幼儿心内直视手术中的临床应用[J].山东大学学报(医学版),2008,46(6):628-630
[96]龚启华,杨一峰,胡建国,等.改良超滤对婴幼儿心内直视手术后血液流变学的影响[J].中国胸心血管外科临床杂志,2006,13(6):389-392.
[97]朱德明,王伟,黄惠民,等,超滤在10公斤以下小儿体外循环中的应用[J].中国体外循环杂志,2003,1(3):134-137.
[98]Skaryak LA,Kirshbom PM,Di Bernardo LR,et al.Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest[J].Thorac Cardiovasc Surg,1995,109:744-752.
[99]赵雨辰,杨一峰,朱云,等.改良超滤在低体重婴幼儿(≤10 kg)体外循环手术中的应用[J].中国医师杂志,2007,19(9):1236-1237.
[100]Ootaki Y,Yamaguchi M,Oshima Y,et al.Effects of modified ultrafiltration on coagulation factors in pediatric cardiac surgery[J].Surg Today,2002,32(3):203-206.
[101]Fujita M,Ishihara M,Kusama Y,et al.Effect of modified ultrafiltration on inflammatory mediators,coagulation factors,and other proteins in blood after an extracorporeal circuit[J].Artif Organs,2004,28(3):310-313.
[102]刘晋萍,王伟鹏,龙村,等.赴美国哥伦比亚儿童医院参观学习见闻[J].中国体外循环杂志,2007,5(1):63-64.
[103]Rosendo A,Rodriguez MD,Marc Ruel.High Flow Rates During Modified Ultrafiltration Decrease Cerebral Blood Flow Velocity and Venous Oxygen Saturation in Infants[J].Ann Thorac Surg,2005,80:22-28.
[104]Battin MR,Penrice J,Gunn TR,et al.Treatment of term infants with head cooling and mild systemic hypothermia(35.0 degreesC and 34.5 degrees C ) after perinatal asphyxia[J].Pediatrics,2003,111(2):244-251.
[105]张鲁英,张广福,姜冠华,等.改良超滤技术在体外循环中的应用[J].中国体外循环杂志,2004,2(1):14-15.[106]Gunn AJ,Gluckman PD,Gunn TR.Selective head cooling in newborn infants after perinatal asphyxia:a safety study[J].Pediatrics,1998,102:885-892.
[107]Schmied H,Kurz A,SesslerDI,et al.Mild hypothermia increases blood loss and transfusion requirements during total hiparthroplasty[J].Lancet,1996,347(8997):289-293.
[108]Anttila V,Hagino I,Zurakowski D,et al.Higher bypass temperature correlates with increased white cell activation in the cerebral microcirculation[J].JThorac Cardiovasc Surg,2004,127(6):1781-1788.
[109]Corbett D,Thornhill J.Temperature modulation(hypothermic and hyperthermic conditions)and its influence on histological and behavioral outcomes following cerebral ischemia[J].Brain Patho,2000,10(1):145-152.
[110]Hennein HA,Kiziltepe U,Barst S,et al.Venous modified ultrafiltration after cardiopulmonary bypass in children:a prospective randomized study[J].J Thorae Cardiovasc Surg,1999,117:496-505.
[111]李刚,芶大明,杜磊,等.变温式改良超滤改善婴幼儿心脏手术的预后[J].中国体外循环杂志,2008,6(4):193-196.
[112]黄惠民,姚廷俊,王伟,等,连续性超滤减轻体外循环肺损伤的研究[J].上海医学,2003;26(10):742-744
[113]Sever K,Tansel T,Basaran M,et al.The benefits of continuous ultrafiltration in pediatric cardiac surgery[J].Scand Cardiovasc,2004,38(5):307-311.
[114]Aggarwal N K,Das S N,Sharma G,et al.Efficacy of combined modified and conventional ultrafiltration during cardiac surgery in children[J].Ann Card Anaesth,2007,10(1):27-33.
[115]刘高利,王安彪,李德才,等.平衡超滤联合改良超滤对婴幼儿体外循环术后肺功能的影响[J].中华小儿外科杂志,2006,27(12):625-627.
[116]Maehara T,Novak I,Elliott MJ.PerioPerative monitoring of total body water by bio-electrical impedance in children undergoing open heart surgery[J].Eur J Cardiothorac Surg,1991,5:258-265.
[117]Onoe M,Magara T,Yamamoto Y,et al.Modified ultrafiltration removes serum interleuking in adult cardiac surgery[J].Perfusion,2001,16(1)37-42.
[118]Finn A,Naik S,Klein N,et al.Interleukin-8 release and neutrophil degranulation after pediatric cardiopulmonary bypass[J].J Thorac Cardiovasc Surg,1993;105:234-239.
[119]Jouronis D,Puopard P,Greeley WJ,et al.Hemofiltration during cardiopulmonary bypass in pediatric cardiac surgery[J].Anesthesiol,1994,81:1181-1189.
[120]Wang MJ,Chiu IS.Hus CM,et al.Efficacy of ultrafiltration in removing inflammatory mediators during pediatric cardiac operations[J].Ann Thorac Surg,1996,61:651-654
[121]Friesen RH,Campbell DN,Clarke DR,et al.Modified ultrafiltration at tenuates dilutional coagulopathy in pediatric open heart operations[J].Ann Thorac Surg,1997,64:1787-1789.
[122]Naik SK,Balaji S,Elliott M.Modified ultrafiltration improves hemnodynamics after cardiopulmonary bypass in children.JACC,1992,19:37.
[123]Davies MJ,Nguyen K,GaynorJW,et al.Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass[J].J Thorac Cardiovase Surg,1998,115:361-369.
[124]Bando K,Vijay P,Turrentine MW,et al.Dilutional and modified ultrafiltration reduces pulmonary hypertension after operations for congenital heart disease:a prospective randomized study[J].J Thorac Cardiovase Surg,1998,115:517-525.
[125]Skaryak LA,Kirshbom PM,Bernardo LR,et al.Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest[J].J Thorac Cardiovase Surg,1995,109:744-752.
[2]Kaulitz R,Jux C,Bertram H,et al.Primary repair of tetralogy of Fallot in infancy-the effect on growth of the pulmonary arteries and the risk for late reinterventions[J].Cardiollogy,2001,11(4):391-398.
[3]Toraman F,Evrenkaya S,Yuce M,et al.Highly positive intraoperative fluid balance during cardiac surgery is associated with adverse outcome[J].Perfusion,2004,19(2):85-91.
[4]Lespron Robles M C.Systemic inflammatory response in pediatric cardiac surgery[J].Arch Cardiol Mex,2006,76(12):92-99.
[5]LequierL.Extracorporeal life support in pediatric and neonatal critical care:a review[J].J Intensive Care Med,2004,19(5):243-258.
[6]Magilligan DJ,Chokeno.Ultrafiltration during cardiopulmonary bypass:laboratory evaluation and initial clinical experience[J].Am Thorae Surg,1984,37:33-39.
[7]Osipor VP,LuricGO,Kohodas MY,et al.Hemoconcentration during open heart operations[J].Thorac Cardiovase Surg,1985,33:81-85.
[8]Nayarsu M,Harada Y,Takeuehi T,et al.Initial ultrafiltration to the priming solution with preserved blood for cardiopulmonary bypass in infants[J].Kyobu Geta,1995,48:281-285.
[9]朱德明,王伟,黄惠民,等,超滤在10公斤以下小儿体外循环中的应用[J].中国体外循环杂志,2003,1(3):134-137.
[10]Naik SK,Knight A,Elliott MJ.A prospective randomized study of a modified technique of ultrafiltration during pediatric open heart surgery[J].Circulation,1991,84(supplⅢ):422-431.
[11]Skaryak LA,Kirshbom PM,Bernardo LR,et al.Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest[J].Thorac Cardiovasc Surg,1995,109:744-752.
[12]石广勇,张供,李跃华,等.改良超滤在婴幼儿心内直视手术中的临床应用[J].山东大学学报(医学版),2008,46(6):628-630
[13]Davies MJ,Nguyen K,Gaynor JW,et al.Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass[J].J Thorac Cardiovasc Surg,1998,115:361-369.
[14]Bando K,Vijay P,Turrentine MW,et al.Dilutional and modified ultrafiltration reduces pulmonary hypertension after operations for congenital heart disease:a prospective randomized study[J].J Thorac Cardiovasc Surg,1998,115:517-525.
[15]赵雨辰,杨一峰,朱云,等.改良超滤在低体重婴幼儿(≤10kg)体外循环手术中的应用[J].中国医师杂志,2007,19(9):1236-1237.
[16]Ootaki Y,Yamaguchi M,Oshima Y,et al.Effects of modified ultrafiltration on coagulation factors in pediatric cardiac surgery[J].Surg Today,2002,32(3):203-206.
[17]Fujita M,Ishihara M,Kusama Y,et al.Effect of modified ultrafiltration on inflammatory mediators,coagulation factors,and other proteins in blood after an extracorporeal circuit[J].Artif Organs,2004,28(3):310-313.
[18]龚启华,杨一峰,胡建国,等.改良超滤对婴幼儿心内直视手术后血液流变学的影响[J].中国胸心血管外科临床杂志,2006,13(6):389-392.
[19]Rosendo A,Rodriguez MD,Marc Ruel.High Flow Rates During Modified Ultrafiltration Decrease Cerebral Blood Flow Velocity and Venous Oxygen Saturation in Infants[J].Ann Thorae Surg,2005,80:22-28
[20]黄惠民,姚廷俊,王伟,等,连续性超滤减轻体外循环肺损伤的研究[J].上海医学2003,26(10):742-744
[21]Sever K,Tansel T,Basaran M,et al.The benefits of continuous ultrafiltration in pediatric cardiac surgery.[J]Stand Cardiovasc,2004,38(5):307-311.
[22]Aggarwal N K,Das S N,Sharma G,et al.Efficacy of combined modified and conventional ultrafiltration during cardiac surgery in children[J].Ann Card Anaesth,2007,10(1):27-33.
[23]刘高利,王安彪,李德才,等.平衡超滤联合改良超滤对婴幼儿体外循环术后肺功能的影响[J].中华小儿外科杂志,2006,27(12):625-627.
[24]Skaryak LA,Kirshbom PM,Di Bernardo LR,et al.Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest[J].Thorac Cardiovase Surg,1995,109:744-752.
[25]Hennein HA,Kiziltepe U,Barst S,et al.Venous modified ultrafiltration after cardiopulmonary bypass in children:a prospective randomized study[J].J Thorae Cardiovasc Surg,1999,117:496-505.
[26]李刚,苟大明,杜磊,等.变温式改良超滤改善婴幼儿心脏手术的预后[J].中国体外循环杂志,2008,6(4):193-196.
[27]高岚、王天龙、杨拨贤,等.心脏瓣膜置换术患者体外循环后肺损伤的机制[J].中华麻醉学杂志,2004,24(7):501-503.
[28]Schroeder S,Borger N,Wrigge H,et al.A tumor necrosis factor gene polymorphism influences the inflammatory response after cadiac operation[J].Ann Thorac Surg,2003,75(2):534-537.
[29]Kiely DG,Cargill RI,Struthers AD,et al.Cardiopulmonary effects of endothelin-1 in man[J].Cardiovasc Res,1997,33(2):378-386.
[30]Fujita M,Ishihara M,Kusama Y,et al.Effect of modified ultrafiltration on inflammatory mediators,coagulation factors,and other proteins in blood after an extracorporeal circuit[J].Artif Organs,2004,28(3):310-318.
[31]Maluf MA,Mangia C,Silva C,et al.Conventional and conventional plus modified ultrafiltration during cardiac surgery in high risk congenital heart disease[J].J Cardiovasc Surg,2001,42(4):465-473.
[32]Keenan HT,Thiagarajan R,Stephens KE,et al.Pulmonary function after modified venorenous ultrafiltration in infants:a prospective,randomized trial[J].J Thorac Cardiovasc Surg,2000,119(3):501-507.
[33]刘晋萍,王伟鹏,龙村,等.赴美国哥伦比亚儿童医院参观学习见闻[J].中国体外循环杂志,2007,5(1):63-64.
[34]Battin MR,Penrice J,Gunn TR,et al.Treatment of term infants with head cooling and mild systemic hypothermia after perinatal asphyxia[J].Pediatrics,2003,111(2):244-251.
[35]张鲁英,张广福,姜冠华,等.改良超滤技术在体外循环中的应用[J].中国体外循环杂志,2004,2(1):14-15.
[36]Gunn AJ,Gluckman PD,Gunn TR.Selective head cooling in newborn infants after perinatal asphyxia:a safety study[J].Pediatrics,1998,102(4 Pt1):885-892.
[37]Schmied H,Kurz A,Sessler DI,et al.Mild hypothermia increases blood loss and transfusion requirements during total hiparthroplasty[J].Lancet,1996,347(8997):289-293.
[38]Anttila V,Hagino I,Zurakowski D,et al.Higher bypass temperature correlates with increased white cell activation in the cerebral microcirculation[J].JThorac Cardiovase Surf,2004, 127(6):1781-1788.
[39]Corbett D,Thomhill J.Temperature modulation (hypothermic and hyperthermic conditions) and its influence on histological and behavioral outcomes following cerebral ischemia [J].Brain Patho,2000,10(1):145-152.
[40]Wan S,Desmet JM,Barvais L,et al.Myocardium is a major source of proinflammatory cytokines in patient undergoing cardiopulmonary bypass[J].J Thorac Cardiovasc Surg,1996,112(3):806-811.
[41]Liebold A,Keyl L,Birnbaum DE,et al.The heart produces,but lungs consume proinflammatory cytokines following cardiopulmonary bypass[J].J Cardiothorac Surg,1999,15(3):340-345.
[42]Wan S,Leclerc JI,Schmart ZD,et al.Hepatic release of interleukin-10 during cardiopulmonary bypass in steroid pretreated patients[J].Am Heart J,1997,133(4):335-339.
[43]Hennein HA,Ebba H,Rodriguez JI,et al.Relationship of the proinflammatory cytokines to myocardial ischemia and dysfunction after uncomplicated coronary revascularization[J].J Thorac Cardiovasc Surg,1994,108(1):625-636.
[44]Kawamura T,Znada K,Okada H,et al.Methylprednisolone inhibits increase of interleukin 8 and 6 during open heart surgery[J].Can J Anaesth,1995,42(3):399-403.
[45]Kalfin RE,Engelman RM,Rousou JA,et al.Induction of interleukin-8 expression during cardiopulmonary bypass[J].Circulation,1993,88:401-406.
[46]Furunaga A,Tsuboi H,Iton H,et al.Significance of systemic inflammatory response syndrome at cardiopulmonary bypass[J].Nippon Kyobu Geda Gakkai Zasshi(Japan),1996,44(6):790-794.
[47]Erez E,Erman A,Snir E,et al.Thromboxane production in human lung during cardiopulmonary bypass:beneficial effect of aspirin? [J].Ann Thorac Surg,1998,65(1):101-106.
[48]Menasche P,Peynet J,Ledeist F,et al.Does temperature in extracorporeal circulation affect neutrophil-endothelium in teractions? [J].Arch Mai Coeur Vaiss,1995,88(10):1415-1423.
[49]Seghage MC,Duchateau J,Bruniaux J,et al.Interleukin-10 release related to cardiopulmonary bypass in infants undergoing cardiac operations[J].J Thorac Cardiovasc Surg,1996,111(1):545-553.
[50]Grunenfelder J,Zund G,Schoeberlein A,et al.Modified ultrafiltration lowers adhesion molecule and cytokine levels after cardiopulmonary bypass without clinical relevance in adults[J].J Cardiothorac Surg,2000,17(1):77-83.
[51]Lichtenstein SV,Abel JG,Panos A,et al.Warm heart surgery experience with long cross-clamp times[J].Ann Thorac Surg,1991,52(4):10009-10013.
[52]Qing M,Vazquez-Jimenez JF,Klosterhalfen B,et al.Influence of temperature during cardiopulmonary bypass on leukocyte activation,cytokine balance,and post-operative organ damage[J].Shock,2001,15(5):372-377.
[53]Mann DL.Chapter 12,Congestive Heart Failure.Second Edition,Philadelphia:Lippincott Williams &Wilkins,2000,213-228.
[54]陈亚丽,王士昌,赵维江.充血性心力衰竭患者血清细胞因子变化与肾素血管紧张素系统相关性的研究[J].临床心血管病杂志,2001,17(1):26-27.
[55]钱方毅.重视心力衰竭发病机制中的神经内分泌细胞因子系统的研究[J].中国循环杂志,2001,16(4):243-251.
[56]傅广,赵水平.心力衰竭患者TNF-α和IL-6的变化及氯沙坦的影响[J]..中国循环杂志,2001,16(4):243-245.
[57]Bozkurt B,Kribbs SB,Clubb F,et al.Pathophysiologically relevant concentrations of tumor necrosis factor alpha promote progressive left ventricular dysfunction and remodeling in rats[J].Circulation,1998,97:1382-1391.
[58]Ichijo H,Nishida E,Irie K,et al.Induction of apoptosis by ASK1,a mammalian MAPKKK that activates SAPK/JNK and P38 signaling pathways[J].Science,1997,275:90-94.
[59]Asimakopoulos G.Mechanisms of the systemic inflammatory response[J].Perfusion,1999,14(4):269-277.
[60]Defoe GR,Ross CS,Olmstead EM,et al.Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass graffing.Northern New England Cardiovascular Disease Study GrouP[J].Ann Thorac Surg,2001,71:769-776
[61]Fang WC,Helm RE,Krieger KH,et al.Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery[J].Circulation,1997,96(Suppl.Ⅱ):194-199
[62]Swaminathan M,Phillips-Bute BG,Conlon PJ,et al.The association of lowest hematocrit during Cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery [J].Ann Thorac Surg,2003,76:784-791
[63]KazmiW H,Kausz AT,Khan S,Anemia:an early complication of chronic renal insufficiency [J].Am J Kidney Dis,2001,38:803-812.
[64]Nollert G,Sperling J,SakamotoT,et al.Higher hematocrit improves liver blood flow and metabolism during cardiopulmonary bypass in piglets[J].Thorac Cardiov Surg,2001,49:226-230.
[65]郑理玲.新型低预充体外循环装置在心脏外科手术中应用的系列研究:[博士学位论文].福建:福建医科大学,2004.
[66]Giomarelli P,Sabino S,Borrelli E,et al.Myocardial and lung injury after cardiopulmonary bypass:role of interleuldn(IL)-10[J].Ann Thorac Surg,2003,76(1):117-123.
[67]McBride WT,Allen S,Gornley SM,et al.Methylprednisolone favourably alters plasma and urinary cytokine homeostasis and subclinical renal injury at cardiac surgery[J].Cytokine,2004,27(2-3):81-89.
[68]Brouicki RA,Backer CL,Baden HP,et al.Dexamethosone reduce the inflammatory response to cardiopulmonary bypass in children[J].Ann Thorac Surg,2000,69(5):1490-1495.
[69]Bach F,Grundmann U,Bauer M,et al.Modulation of the inflammatory response to cardiopulmonary bypass by dopexamine and epidural anesthesia[J].Acta Anaesthesiol Scand,2002,46(10):1227-1235.
[70]Tayama E,Hayashida N,Fukunaga S,et al.High-dose cimetidine reduces proinflammatory reaction after cardiac surgery with cardiopulmonary bypass[J].Ann Thorac Surg,2001,72(6):1945-1949.
[71]Brull DJ,Sanders J,Rumley A,et al.Impact of angiotensin converting enzyme inhibition on post-coronary artery bypass interleukin-6 release[J].Heart,2002,87(3):252-255.
[72]徐康清,孙培吾,黄文起,等.乌司他丁对体外循环心脏手术后肺功能的影响[J].中华胸心血管外科杂志,2004,20(1):7-9.
[73]Li D,Zhao L,Liu M,et al.Kineties of tumor necrosis factor alpha in plasma and the cardioprotective effect of a monoclonal antibody to tumor necrosis factor alpha in acute myocardial infarction[J].Am Heart J,1999,137(6):1145-1152.
[74]Fitch JC,Rollins S,Matis L,et al.Pharmacology and biological efficacy of a recombinant, humanized,single-chain antibody C_5 complement inhibitor in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass[J].Circulation,1999,100(25):2499-2506.
[75]Mojcik CF,Levy JH.Aoprotinin and the systemic inflammatory response after cardiopulmonary bypasss[J].Ann ThoracSurg,2001,71(2):745-754.
[76]Hill GE,Alonso A,Spurzem JR,et al.Aprotinin and methylprednisolone equally blunt cardiopulmonary bypass induced inflammatory reaction in humans[J].J Thorac Cardiovasc Surg,1995,110(5):1658-1662.
[77]PalluaN,Low JF,Heimburg D.Pathogenic role of interleukin-6 in the development of sepsis.Part Ⅱ:Significance of anti-interleukin-6 and anti-soluble interleukin-6 receptor-alpha antibodies in a standardizedmurine contactburn model[J].Crit Care Med,2003,31(5):1495-1501.
[78]辛惠霞,王心田.抑肽酶致过敏性休克82例回顾性分析[J].中国药房,2005,16(8):616-617.
[79]Mangano DT,Miao Y,Vuylsteke A,et al.Investigators of The Multicenter Study of Perioperative Ischemia Research Group;Ischemia Research and Education Foundation[J].JAMA,2007,297(5):471-479.
[80]Richter JA,Meisner H,Tassani P,et al.Drew-Anderson technique attenuates systemic inflammatory response syndrome and improves respiratory function after coronary artery bypass grafting[J].Ann Thorac Surg,2000,69(1):77-83.
[81]Palatianos GM,Balentine G,Papadakis EG,et al.Neutrophil depletion reduces myocardial reperfusion morbidity[J].Ann Thorac Surg,2004,77(3):956-961
[82]Karaiskos TE,Palatianos GM,Triantafillou CD,et al.Clinical effectiveness of Leukocyte filtration during cardiopulmonary bypass in patients with chronic obstructive pulmonary disease[J].Ann ThoracSurg,2004,78(4):1339-1344.
[83]Grossi EA,Kallenbach K,Chau S,et al.Impact of heparin bonding on pediatric cardiopulmonary bypass:a prospective randomized study[J].Ann Thorac Surg,2000,70(1):191-196.
[84]Jensen E,Andreasson S,Bengtsson A,et al.Influence of two different perfusion systems on inflammatory response in pediatric heart surgery[J].Ann Thorac Surg,2003,75(3):919-925.
[85]Harig F,FeyrerR,Mahmoud FO,et al.Reducing the post-pump syndrome by using heparincoated circuits,steroids,oraprotinin[J].Thorac Cardiovasc Surg,1999,47(2):111-118.
[86]Harig F,Hohenstein B,Vonder J,et al.Modulating IL-6 and IL-10 levels by pharmacologic strategies and the impact of different cardiopulmonary bypass parameters during cardiac surgery[J].Shock,2001,16 Suppll:33-38.
[87]InuiK,ShimazakiY,WatanadeT,et al.Effects of duraflo Ⅱ heparin-coated cardiopulmonary bypass circuits on the coagulalon system,endothelial damage,and cytokine release in patients with cardiac operation employing aprotinin and steroids[J].Artif Organs,1999,23(12):1107-1112.
[88]Naik SK,Elliott MJ.Ultrafiltration and pediatric cardiopulmonary bypass[J].Perfusion,1993,8:101-112.
[89]Yuiehiron N,Mneteka M,Yoshihro T,et al.Conparative study of cell saver and ultrafiltration nontransfusion in cardiac surgery[J].Ann Thorac Surg,1990,49:973-978.
[90]Naik SK,Balaji S,Elliott M.Modified ultrafiltration improves hemnodynamics after cardiopullnonary bypass in children[J].JACC,1992,19:37.
[91]吴华.不同膜平衡超滤影响体外循环炎症反应的临床研究:[博士学位论文].广州:第一军医大学,2004.
[92]Williams GD,Ramamoorthy C.The routine use of aproyinin during pediatric cardiac surgery is not a benefit[J].J Cardiothrac and Vase Anesth,1999,13:785-790.
[93]Jouronis D,Puopard P,Greeley WJ,et al.Hemofiltration during cardiopulmonary bypass in pediatric cardiac surgery[J].Anesthesiol,1994,81:1181-1189.
[94]Journois D,Israel-Biet D,Pouard P,et al.High volume,zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children[J].Anesthesiology,1996,86:965-976.
[95]田步升,李国荣,崔爱玲,等.负压对机械转流管道中血流溶血过程的影响[J].中华物理医学与康复杂志,2000,22(3):181-182.
[96]段大为,陈德凤,王晓莉,等.体外循环过程中引起血红蛋白尿的原因分析[J].生物医学工程与临床,2000,4(2)101-104.
[97]万彩虹,董培青,杨璟,等.体外循环对红细胞流变学特性和形态的影响[J].中国体外循环杂志,2003,1(4):216-218.
[98]Holloway DS,Summaria L,Sandesara J,et al.Decreased platelet number and function and increased fibrinolysis contribute to post-operative bleeding in cardiopulmonary bypass patients[J].Thromb Haemost,1988,59(1):62.
[99]Kayuthof M.Inhibition of platelet adhesion during cardiopulmonary bypass reduces postoperative bleeding[J].Circulation,1994,90(1):269-274.
[100]Hard JF,Belisle S.Natural and synthetic antifibrinolytics in adult cardiac surgery:efficacy,effectiveness and efficiency[J].Can J Anesth,1994,41(11):1104-1112.
[101]王庆善,张荣振,许大庆,等.体外循环期间D-二聚体的变化[J].中华胸心外科杂志,1998,14(1):5-6.
[102]马乐龙,刘平波,高纪平,等.7公斤以下婴幼儿先天性心脏病根治术[J].临床小儿外科杂志,2006,5(1):20-22.
[103]Mangano DT.Beyond CK-MB biochemical markers for perioperative myocardial infarction [J].Anesthesiology,1994,81:1317-1320.
[104]Eigel P,Van Ingen G,Wagenpfeil S.Predictive value of perioperative cardiac troponin I for adverse outcom in coronary artery bypass surgery[J].Eur J Cardiothorac Surg,2001,20:544-549.
[105]Nahum N,Zisman E,Wolf T,et al.Strict thermo regulation attenuates myocardial injury during coronary artery bypass graftsurgery as reflected by reduced levels of cardiac-specific troponin I[J].Anesth Analg,2003,96:328-335.
[106]范丹,谢东篱,谢先丰,等.体温调节在先天性心脏病患儿手术中对心肌酶的影响[J].临床麻醉学杂志,2008,24(6):465-467.
[107]薛富善,赵俊.体温与麻醉[J].临床麻醉学杂志,1992,8:180-183.
[108]Frank SM,Fleisher LA,Breslow MJ,et al.Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events.A randomized clinical trial[J].JAMA,1997,277:1127-1129
[109]Nollert G,Reichart B.Cardiopulmonary bypass and cerebral injury in adults[J].Shock,2001,16(Suppl Ⅰ):16-19.
[110]Schell RM,Kem FH,Greeley WJ,et al.Cerebral blood flow and metabolism during cardiopulmonary bypass[J].Anesth Analg,1993,76(4):849-865.
[111]Aoki-S.The evaluation of cerebral oxygen balance during moderate hypothermic cardiopulmonary bypass[J].Masui,1995,44(l 1):1520-1526.
[112]Enomoto S,Hindman BJ,DeXter F,et al.Rapid rewarming causes an increase in the cerebral metabolic rate for oxygen that is temporarily unmatched by cerebral blood flow[J].Anesthesiology,1996,84(6):1392-1400.
[113]Croughwell ND,Fraseo P,Blumefthal JA,et al.warming during cardiopulmonary bypass is associated with jugular bulb desaturation[J].AnnThoracsurg,1992,52:827-832.
[114]Nakajima T,Kuro M,Hayashi Y,et al.Clinical evaluation of cerebral oxygen balance during cardiopulmonary bypass:on-line continuous monitoring of jugular venous oxyhemoglobin saturation[J].Anesth Analg,1992,74(5):630-635.
[115]Dearden NM.Jugular bulb venous oxygen saturation in the management of severe head injury[J].Curr Opin Anesthesiol,1991,4:279-286.
[116]Kadoi Y,Saito S,Takahashi K.Jugular venous oxygen saturation during mild hypothermic versus normothermic cardiopulmonary bypass in elderly patients[J].Surg Today,2004,34(5):399-404.
[117]Hindman BJ,Todd MM.Gelb AW et al.Mild hypothermia as a protective therapy during intracranial aneurysm surgery:a randomized prospective pilot trial[J].Neurosurgery,1999:44:23-32
[118]Jansen GF,Wan Praagh BH,Kedaria MB,et al.Jugular bulb oxygen saturation during propofol and isoflurane/nitrous oxide anesthesia in patients undergoing brain tumor surgery [J].Anesth Analg.,1999,89(2):358-363.
[119]Braekken SK,Russell D,Brucher R,et al.Cerebral microembolic signals during cardiopulmonary bypass surgery.frequency,time of occurrence,and association with patient and surgical characteristics[J].Stroke,1997,28(10):1988-1992.
[120]Pugsley W,Klinger L.Pasehalis C,et al.The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning [J].Stroke,1994,25:1393-1399.
[121]Sylivris S,Levi C,Matalanis G,et al.Patten and significance of cerebral mieroemboli during coronary artery bypass grafting[J].Ann Thorac Surg,1998,66:1674-1678.
[122]Brown WR,Moody DM,ChallaVR,et al.Longer duration of cardiopulmonary bypass is associated with greater numbers of cerebral microemboli [J].Stroke,2000,31:707-713.
[123]Taggart DP.Bhattacharya K,Meston N,et al.Serum S-100 protein concentration after cardiac surgery:a randomized trial of arterial line filtration[J].Eur J Cardiothorac Surg,1997,11(4):645-649.
[124]Brooker RF,Brown WR,Moody DM.et al.Cardiotomy suction:a major source of brain lipid emboli during cardiopulmonary bypass[J].Ann Thorac Surg,1998,65:1651-1655.
[125]Nandate K,Vuylsteke A,Crosbie AE,et al.Cerebrovascular cytokine responses during coronary artery bypass surgery:specific production of interleukin-8 and its attenuation by hypothermic cardiopulmonary bypass[J].Anesth Analg,1999,89:823-828.
[126]Wan S,Desnet JM,Barvais L,et al.Myocardium is a major source of inflammatory cytokines in patients undergoing cardiopulmonary bypass[J].Thorac Cardiovasc Surg,1996,112:806-811.
[127]Kawamura T,Wakusawa R,Okada K,et al.Elevation of cytokines during open heart surgery with cardiopulmonary bypass:Participant of interleukin-8 and 6 in reperfusion injury [J].Can J Anaesth,1993,40:1016-1022.
[128]Ashraf SS,Tian Y,Zacharrias S,et al.Effeets of cardiopulmonary bypass on neonatal and pediatric inflammatory profiles[J].Eur J Cardiothorac Surg,1997,12(6):862-868.
[129]Robertson CS,Narayan RK,Gokaslan ZL,et al.Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients[J].J Neuro surg,1989,70(2):222-230.
[130]Gopinath SP,Cormio M,Ziegler J,et al.Intraoperative jugular desaturation during sugery for traumatic iniracranial hematomas[J].Anesth Analg,1996,83(5):1014-1021.
[131]Perez A.Minces PG,Sehnitzler EJ,etal.Jugular venous oxygen saturationor arteriovenous difference of lactate content and outcome in children with severe traumatic brain injury [J].Pediatr Crit Care Med,2003,4(1):33-38.
[132]Reinert M,Alessandri B.Seiler R,et al.Influence of inspired oxygen on glucose-lactate dynamics after subdural hematoma in the rat[J].Neurol Res,2002,24(6):601-606.
[133]Ng CS.Wang S,Yim AP,et a.l Pulmonary dysfunction after cardiac surgery[J].Chest,2002,121(4):1269-1277.
[134]SieversH,Freand K,Eleftheriadis S,et al.Lung protection during total cardiopulmonary bypass by isolated lung perfusion:result so fanovel perfusions trategy[J].Ann Thorac, 2003,76(2):516-521.
[135]Chai PJ,Williamson JA,Lodge AJ,et al.Effects of ischemia on pulmonary dysfunction after cardiopulmonary bypass[J].Ann Thorac Surg,1999,67(3):731-735.
[136]Jansen PG,Velthuis H,Huybregts RA,et al.Reduced complement activation and improved postoperative performance after cardiopulmonary bypass with heparin-coated circuitsl [J].J Thorac Cardiovasc Surg,1995,110(3):829-841.
[137]de Mendonca-Filho HT.Gomes RV,de Almeida Campos LA.et al.Circulating levels of macrophagemigration inhibitory factor are associated with mild pulmonary dysfunction after cardiopulmonary bypass [J].Shock,2004,22(6):533-537.
[138]Giomarelli P,Scolletta S,Borrelli E,et al.Myocardialand lung injury after cardiopulmonary bypass:role of interleukin(IL)-10 [J].Ann Thorac Surg,2003,76(1):117-123.
[139]Rinder CS,Rinder HM,Smith MJ,et al.Antithrombin reduces monocyte and neutrophil CD11b up regulation in addition to blocking platelet activation during extracorporeal circulation[J].Transfusion,2006,46(7):1130-1137.
[140]Kovesi T,Szabo A,Royston D,et al.Correlation between pulmonary gas exchange and basal and nitroglycerin-induced exhaled nitric oxide in patients undergoing cardiac surgery [J].Vascul Pharmacol,2005,43(6):434-440.
[141]Schlensak C,Doenst T,Preusser S,et al.Cardiopulmonary bypass reduction of bronchial blood flow:a potential mechanism for lung injury in a neonatal pig model [J].J Thorac Cardiovasc Surg,2002,123(6):1199-1205.
[142]Suzuki T,Fukuda T.Continuous pulmonary perfusion during cardiopulmonary bypass prevents lung injury in infants [J].Ann Thorac Surg,2000,69(2):602-606.
[143]Babik B,Asztalos T,Petak F,et al.Changes in respiratory mechanics during cardiac surgery[J].Anesth Analg,2003,96(5):1280-1287.
[144]Schultz JM.Karamlou T,Swanson J,et al.Hypothermic low-flow cardiopulmonary bypass impairspulmonary and right ventricular function more than circulatory arrest[J].AnnThorac Surg,2006,81(2):474-80.
[1]Toraman F,Evrenkaya S,Yuce M,et al.Highly positive intraoperative fluid balance during cardiac surgery is associated with adverse outcome[J].Perfusion,2004,19(2):85-91.
[2]Lespron Robles M C.Systemic inflammatory response in pediatric cardiac surgery[J].Arch Cardiol Mex,2006,76(12):92-99.
[3]LequierL.Extracorporeal life support in pediatric and neonatal critical care:a review[J].J Intensive Care Med,2004,19(5):243-258.
[4]Naik SK,Elliott MJ.Ultrafiltration and pediatric cardiopulmonary bypass[J].Perfusion,1993,8:101-112.
[5]Adam D,Surem N,NigelK,et al.Interleukin-8 release and neutrophilde granulation after pediatric cardiopulmonary bypass[J].Thorca Cardiovasc Surg,1993,105:234-241.
[6]Wan S,Desmet JM,Barvais L,et al.Myocardium is a major source of proinflammatory cytokines in patient undergoing cardiopulmonary bypass[J].J Thorac Cardiovasc Surg,1996,112(3):806-811.
[7]Rinder CS,FontesM,Mathew JP,et al.Neutrophil CD11b up regulation during cardiopulmonary bypass is associated with postoperative renal injury[J].AnnThorac Surg,2003,75(3):899-905.
[8]Massoudy P,Zahler S,Becker BF,et al.Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with cardiopulmonary bypass[J].Chest,2001,119(1):31-36.
[9]Antonelli M,Testa G,Tritapepe L,et al.IL-8,IL-6 and ICAM-1 in serum of pediatric patients undergoing cardiopulmonary bypass with and without cardiocirculatory arrest[J].J Cardiovasc Surg(Torino),1999,40(6):803-809.
[10]Aebert H,Kirchner S,Keyser A,et al.Endothelial apoptosis is induced by serum of patients after cardiopulmonary bypass[J].Eta JCardiothorac Surg,2000,18(5):589-593
[11]Elliot MJ.Ultraflltration and modified ultrafiltration in pediatric open heart operations[J].Ann Thorac Stag,1993,65:1518-1522.
[12]Milllar AB,Armstong L,Linderetal.Cytokine production and hemofiltration in children undergoing cardiopulmonary bypass[J].Am Thorac Stag,1993,56:1499-1502.
[13]Defoe GR,Ross CS,Olmstead EM,et al.Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass graffing.Northern New England Cardiovascular Disease Study Group[J].Ann Thorac Surg,2001,71:769-776.
[14]Fang WC,Helm RE,Krieger KH,et al.Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery[J].Circulation,1997,96(Suppl.Ⅱ):194-199.
[15]Swaminathan M,Phillips-Bute BG,Conlon PJ,et al.The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery[J].Ann Thorac Surg,2003,76:784-791.
[16]Kazmi WH,Kausz AT,Khan S.Anemia:an early complication of chronic renal insufficiency[J].Am J Kidney Dis,2001,38:803-812.
[17]Nollert G,Sperling J,SakamotoT,et al.Higher hematocrit improves liver blood flow and metabolism during cardiopulmonary bypass in piglets[J].Thorae Cardiov Surg,2001,49:226-230.
[18]郑理玲.新型低预充体外循环装置在心脏外科手术中应用的系列研究:[博士学位论文].福建:福建医科大学,2004.
[19]薛富善,赵俊.体温与麻醉[J].临床麻醉学杂志,1992,8:180-183.
[20]Frank SM,Fleisher LA,Breslow MJ,et al.Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events.A randomized clinical trial[J].JAMA,1997,277:1127-1129.
[21]范丹,谢东篱,谢先丰,等。体温调节在先天性心脏病患儿手术中对心肌酶的影响[J]. 临床麻醉学杂志,2008,24(6):465-467.
[22]Magilligan DJ,Chokeno.UltrafiItration during cardiopulmonary bypass:laboratory evaluation and initial clinical exprience[J].Am Thorae Surg,1984,37:33-39.
[23]Osipor VP,Luric GO,Kohodas MY,et al.Hemoconcentration during open heart operations [J].Thorac Cardiovase Surg,1985,33:81-85.
[24]Darling EM,Shearer R,Katharine N et al.Modified ultrafiItration in pediatric cardiopulmonary bypass[J].J Extra Corppor Tech,1994,26:205-209.
[25]Stark J著.朱晓东主译.先天性心脏病外科学[M].北京:人民卫生出版社,1996,136-150.
[26]Rabinoriteh M.Problems of pulmonary hypertension in children with congenital heart disease [J].Chest,1998,93:1195.
[27]吉冰洋.体外循环后肺损伤和急性呼吸窘迫综合征[J].心血管病学进展,2002,23(3):158-160.
[28]Sehlensak C,Doenst T,Preusser S,et al.Cardiopulmonary bypass reduction of bronchial blood flow:a potential mechanism for lung injury in a neonatal pig model[J].J Thorac Cardiovase Surg,2002,123(6):1199-1205.
[29]Suzuki T,Fukuda T.Continuous pulmonary perfusion during cardiopulmonary bypass prevents lung injury in infants[J].Ann Thorac Surg,2000,69(2):602-606.
[30]陈亚丽,王士昌,赵维江.充血性心力衰竭患者血清细胞因子变化与肾素血管紧张素系统相关性的研究[J].临床心血管病杂志,2001,17(1):26-27.
[31]钱方毅.重视心力衰竭发病机制中的神经内分泌细胞因子系统的研究[J].中国循环杂志,2001,16(4):243-251.
[32]傅广,赵水平.心力衰竭患者TNF-α和IL-6的变化及氯沙坦的影响[J].中国循环杂志,2001,16(4):243-245.
[33]Hennein HA,Ebba H,Rodriguez JI,et al.Relationship of the proinflammatory cytokines to myocardialischemia and dysfunction after uncomplicated coronary revascularization[J].JThorac Cardiovasc Surg,1994,108(1):625-636.
[34]Zkurt B,Kribbs SB,Clubb F,et al.Pathophysiologically relevant concentrations of tumor necrosis factor-alpha promote progressive left ventricular dysfunction and remodeling in rats[J].Circulation,1998,97:1382-1391.
[35]Ichijo H,Nishida E,Irie K,et al.Induction of apoptosis by ASK1,amammalian MAPKKK that activates SAPK/JNK and P38 sigaling patllways [J].Science,1997,275:90-94.
[36]Nollert G.Reichart B.Cardiopulmonary bypass and cerebral injury inadults[J].Shock.,2001,16(SupplⅠ):16-19.
[37]Schell RM,Kem FH,Greeley WJ,et al.Cerebral blood flow and metabolism during cardiopulmonary bypass[J].Anesth Analg,1993,76(4):849-865.
[38]Aoki-S.The evaluation of cerebral oxygen balance during moderate hypothermic cardiopulmonary bypass[J].Masui,1995,44(11):1520-1526.
[39]Enomoto S,Hindman BJ.DeXter F,et al.Rapid rewarming causes an increase in the cerebral metabolic rate for oxygen that is temporarily unmatched by cerebral blood flow[J].Anesthesiology,1996,84(6):1392-1400.
[40]Croughwell ND,Fraseo P.Blumefthal JA.et al.warming during cardiopulmonary bypass is associated with jugular bulb desaturation[J].AnnThoracsurg,1992,52:827-832.
[41]Nakaj ima T,Kuro M,Hayashi Y,et al.Clinical evaluation of cerebral oxygen balance during cardiopulmonary bypass:on-line continuous monitoring of jugular venous oxyhemoglobin saturation[J].AnesthAnalg,1992,74(5):630-635.
[42]Dearden NMJugular bulb venous oxygen saturation in the management of severe head injury[J].Curr Opin Anesthesiol,1991,4:279-286.
[43]Kadoi Y,Saito S,Takahashi K.Jugular venous oxygen saturation during mild hypothermic versus normothermic cardiopulmonary bypass in elderly patients[J].Surg Today,2004,34(5):399-404.
[44]Hindman BJ.Todd MM.Gelb AW et al.Mild hypothermia as a protective therapy during Intracranial aneurysm surgery:a randomized prospective pilot trial[J].Neurosurgery,1999,44:23-32
[45]Jansen GF.Wan Praagh BH,Kedaria MB.et al.Jugular bulb oxygen saturation during propofol and isoflurane/nitrous oxide anesthesia in patients undergoing brain tumor surgery[J].Anesth Analg,1999,89(2):358-363.
[46]Braekken SK,Russell D,Brucher R,et al.Cerebral microembolic signals during cardiopulmonary bypass surgery.frequency,time of occurrence,and association with patient and surgical characteristics[J].Stroke,1997,28(10):1988-1992.
[47]Pugsley W,Klinger L,Pasehalis C.et al.The impact of microemboli during cardiopulmonary bypass on neuropsyehological functioning[J].Stroke,1994,25:1393-1399.
[48]Sylivris S,Levi C,Matalanis G,et al.Patten and significance of cerebral mieroemboli during Coronary artery bypass grafting[J].Ann Thorac Surg,1998,66:1674-1678.
[49]Brown WR,Moody DM.ChallaVR,etal.Longer duration of cardiopulmonary bypass is associated with greater numbers of cerebral microemboli[J].Stroke,2G00,31:707-713.
[50]Taggart DP,Bhattacharya K,Meston N,et al.Serum S-100 protein concentration after cardiac surgery:a randomized trial of arterial line filtration[J].Eur J Cardio thorac Surg,1997,11(4):645-649.
[51]Brooker RF,Brown WR,Moody DM,et al.Cardiotomy suction:a major source of brain lipid emboli during cardiopulmonary bypass[J].Ann Thorac Surg,1998,65:1651-1655.
[52]Nandate K,Vuylsteke A,Crosbie AE,et al.Cerebrovascular cytokine responses during coronary artery bypass surgery:specific production of interleukin-8 and its attenuation by hypothermic cardiopulmonary bypass[J].Anesth Analg,1999,89:823-828.
[53]Wan S,DeSnet JM,Barvais L,et al.Myocardium is a major source of inflammatory cytokines in patients undergoing cardiopulmonary bypass[J].Thorac Cardiovasc Surg,1996,112:806-811.
[54]Kawamura T,Wakusawa R,Okada K,et al.Elevation of cytokines during open heart surgery with cardiopulmonary bypass:Participant of interleukin-8 and 6 in reperfusion injury[J].Can J Anaesth,1993,40:1016-1022.
[55]Ashraf SS,Tian Y,Zacharrias S,et al.Effeets of cardiopulmonary bypass on neonatal and pediatric inflammatory profiles[J].Eur J Cardiothorac Surg,1997,12(6):862-868.
[56]Fleming F,Bohn D,Edwards.Renal replacement therapy after repair of congenital heart disease in children acomprason of hemofiltration and peritoneal dialysis[J].Thorac Cardiovasc Surg,1995,109(2):322-331.
[57]Suen WS,Mok CK,Chiu SW,et al.Risk factors for development of acute renal failure(ARF)requiring dialysis in patients undergoing cardiac surgery[J].Angiolgy,1998,49(10):789-800.
[58]ManganoCM,Diamondstone LS,Ramsay JQ,et al.Renal dysfunction after myocardial revascularization:risk factors,adverse outcomes,and hospital resource utilization.The Multi Center Study of Perioperative Isehemia Research Group[J].Ann Intern Med,1998,128(3):194-203.
[59]Meldrum DR,Donnalloo KK.Role of TNF in mediating renal in sufficiency following cardiac surgery:evidence of a post bypass cardio renal syndrome[J]Surg Res,1999,85(2):185-199.
[60]Zanardo G,Miehielon P,Paecagnella A,et al.Acute renal failure in the patient undergoing cardiac operation,prevalence,mortality rate,and main risk faetors[J].Thorac Cardiovasc Surg,1994,107(6):1489-1495.
[61]Shahzad G.Raja.The 'dark side' of cardiopulmonary bypass[J].European Journal of Cardiothoracic Surgery,2004,25:905-907.
[62]Wehlin L,Vedin J,Vaage J,et al.Activation of complement and leukocyte receptors during on- and off pump coronary artery bypass surgery[J].Eur J Cardiothorac Surgery,2004,25:35-42.
[63]Giomarelli P,Sabino S,Borrelli E,et al.Myocardial and lung injury after cardiopulmonary bypass:role of interleukin(IL)-10[J].Ann Thorac Surg,2003,76(1):117-123.
[64]McBride WT,Allen S,Gornley SM,et al.Methylprednisolone favourably alters plasma and urinary cytokine homeostasis and subclinical renal injury at cardiac surgery[J].Cytokine,2004,27(2-3):81-89.
[65]Brouicki RA,Backer CL,Baden HP,et al.Dexamethosone reduce the inflammatory response to cardiopulmonary bypass in children[J].Ann Thorac Surg,2000,69(5):1490-1495.
[66]Bach F,Grundmann U,Bauer M,et al.Modulation of the inflammatory response to cardiopulmonary bypass by dopexamine and epidural anesthesia[J].Acta Anaesthesiol Scand,2002,46(10):1227-1235.
[67]Tayama E,Hayashida N,Fukunaga S,et al.High-dose cimetidine reduces proinflammatory reaction after cardiac surgery with cardiopulmonary bypass[J].Ann Thorac Surg,2001,72(6):1945-1949.
[68]Brull DJ,Sanders J,Rumley A,et al.Impact of angiotensin converting enzyme inhibition on post-coronary artery bypass interleukin 6 release[J].Heart,2002,87(3):252-255.
[69]Pallua N,Low JF,Heimburg D.Pathogenic role of interleukin-6 in the development of sepsis.Part Ⅱ:Significance of anti-interleukin-6 and anti-soluble interleukin-6 receptor-alpha antibodies in a standardized mudne contact burn model[J].Crit Care Med,2003,31(5):1495-1501.
[70]Li D,Zhao L,Liu M,et al.Kinetics of tumor necrosis factor alpha in plasma and the cardioprotective effect of a monoclonal antibody to tumor necrosis factor alpha in acute myocardial infarction[J].Am Heart J,1999,137(6):1145-1152.
[71]Fitch JC,Rollins S,Matis L,et al.Pharmacology and biological efficacy of a recombinant,humanized,single-chain antibody C_5 complement inhibitor in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass[J].Circulation,1999,100(25):2499-2506.
[72]徐康清,孙培吾,黄文起,等.乌司他丁对体外循环心脏手术后肺功能的影响[J].中华胸心血管外科杂志,2004,20(1):7-9.
[73]Mojcik CF,Levy JH.Aoprotinin and the systemic inflammatory response after cardiopulmonary bypasss[J].Ann Thorac Surg,2001,71(2):745-754.
[74]Hill GE,Alonso A,Spurzem JR,et al.Aprotinin and methylprednisolone equally blunt cardiopulmonary bypass induced inflammatory reaction in humans[J].J Thorac Cardiovasc Surg,1995,110(5):1658-1662.
[75]辛惠霞,王心田.抑肽酶致过敏性休克82例回顾性分析[J].中国药房,2005,16(8):616-617.
[76]Mangano DT,Miao Y,Vuylsteke A,et al.Investigators of The Multicenter Study of Perioperative Ischemia Research Group;Ischemia Research and Education Foundation[J].JAMA,2007(5):471-479.
[77]Richter JA,Meisner H,Tassani P,et al.Drew-Anderson technique attenuates systemic inflammatory response syndrome and improve s respiratory function after coronary artery bypass grafting[J].AnnThoracSurg,2000,69(1):77-83.
[78]Palatianos GM,Balentine G,Papadakis EG,et al.Neutrophil depletion reduces myocardial reperfusionmorbidity[J].Ann Thorac Surg,2004,77(3):956-961
[79]Karaiskos TE,Palatianos GM,Triantafillou CD,et al.Clinical effectiveness of Leukocyte filtration during cardiopulmonary bypass in patients with chronic obstructive pulmonary disease[J].Ann Thorac Surg,2004,78(4):1339-1344.
[80]Grossi EA,Kallenbach K,Chau S,et al.Impact of heparin bonding on pediatric cardiopulmonary bypass:a prospective randomized study[J].Ann Thorac Surg,2000,70(1):191-196.
[81]Jensen E,Andreasson S,Bengtsson A,et al.Influence of two different perfusion systems on inflammatory response in pediatric heart surgery[J].Ann Thorac Surg,2003,75(3):919-925.
[82]Harig F,FeyrerR,Mahmoud FO,et al.Reducing the post-pump syndrome by using heparincoated circuits,steroids,or aprotinin[J].Thorac Cardiovasc Surg,1999,47(2):111-118.
[83]Harig F,Hohenstein B,Vender J,et al.Modulating IL-6 and IL-10 levels by pharmacologic strategies and the impact of different cardiopuhnonary bypass parameters during cardiac surgery[J].Shock,2001,16 Suppl1:33-38.
[84]Inui K,Shimazaki Y,Watanade T,et al.Effects of Duraflo Ⅱ heparin-coated cardiopulmonary bypass circuits on the coagulaion system,endothelial damage,and cytokine release in patients with cardiac operation employing aprotinin and steroids[J].Artif Organs,1999,23(12):1107-1112.
[85]Yuiehiron N,Mneteka M,Yoshihro T,et al.Comparative study of cell saver and ultrafiltration nontransfusion in cardiac surgery[J].Ann Thorac Surg,1990,49:973-978.
[86]Nayarsu M,Harada Y,Takeuehi T,et al.Initial ultrafiltration to the priming solution with preserved blood for cardiopulmonary bypass in infants[J].Kyobu Geta,1995,48:281-285.
[87]吴华.不同膜平衡超滤影响体外循环炎症反应的临床研究:[博士学位论文].广州:第一军医大学,2004.
[88]Williams GD,Ramamoorthy C.The routine use of aproyinin during pediatric cardiac surgery is not a benefit[J].J cardiothrac and Vase.Anesth,1999,13:785-790.
[89]Jouronis D,Puopard P,Greeley WJ,et al.Hemofiltration during cardiopulmonary bypass in pediatric cardiac surgery[J].Anesthesiol,1994,81:1181-1189.
[90]Naik SK,Knight A,Elliontt MJ.A prospective randomized study of a modified technique of ultrafiltration during pediatric open heart surgery[J].Circulation,1991,84(SupplⅢ):422-431.
[91]Boldt J,Kling D,Bormann BV,et al.Extravascular lung water and hemofiltration during complicated cardiac surgery[J].Thorac Cardiovase Surg,1987,35:161-165.
[92]Skaryak LA,Kirshbom PM,Di Bernardo LR,et al.Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest[J].Thorac Cardiovasc Surg,1995,109:744-752.
[93]Journois D,Israel-Biet D,Pouard P,et al.High volume,zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children[J].Anesthesiology, 1996,86:965-976.
[94]Naik SK,Knight A,Elliott MJ.A successful modification of ultrafiltration for cardiopulmonary bypass in children[J].Perfusion,1991,6:41-50.
[95]石广勇,张供,李跃华,等.改良超滤在婴幼儿心内直视手术中的临床应用[J].山东大学学报(医学版),2008,46(6):628-630
[96]龚启华,杨一峰,胡建国,等.改良超滤对婴幼儿心内直视手术后血液流变学的影响[J].中国胸心血管外科临床杂志,2006,13(6):389-392.
[97]朱德明,王伟,黄惠民,等,超滤在10公斤以下小儿体外循环中的应用[J].中国体外循环杂志,2003,1(3):134-137.
[98]Skaryak LA,Kirshbom PM,Di Bernardo LR,et al.Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest[J].Thorac Cardiovasc Surg,1995,109:744-752.
[99]赵雨辰,杨一峰,朱云,等.改良超滤在低体重婴幼儿(≤10 kg)体外循环手术中的应用[J].中国医师杂志,2007,19(9):1236-1237.
[100]Ootaki Y,Yamaguchi M,Oshima Y,et al.Effects of modified ultrafiltration on coagulation factors in pediatric cardiac surgery[J].Surg Today,2002,32(3):203-206.
[101]Fujita M,Ishihara M,Kusama Y,et al.Effect of modified ultrafiltration on inflammatory mediators,coagulation factors,and other proteins in blood after an extracorporeal circuit[J].Artif Organs,2004,28(3):310-313.
[102]刘晋萍,王伟鹏,龙村,等.赴美国哥伦比亚儿童医院参观学习见闻[J].中国体外循环杂志,2007,5(1):63-64.
[103]Rosendo A,Rodriguez MD,Marc Ruel.High Flow Rates During Modified Ultrafiltration Decrease Cerebral Blood Flow Velocity and Venous Oxygen Saturation in Infants[J].Ann Thorac Surg,2005,80:22-28.
[104]Battin MR,Penrice J,Gunn TR,et al.Treatment of term infants with head cooling and mild systemic hypothermia(35.0 degreesC and 34.5 degrees C ) after perinatal asphyxia[J].Pediatrics,2003,111(2):244-251.
[105]张鲁英,张广福,姜冠华,等.改良超滤技术在体外循环中的应用[J].中国体外循环杂志,2004,2(1):14-15.[106]Gunn AJ,Gluckman PD,Gunn TR.Selective head cooling in newborn infants after perinatal asphyxia:a safety study[J].Pediatrics,1998,102:885-892.
[107]Schmied H,Kurz A,SesslerDI,et al.Mild hypothermia increases blood loss and transfusion requirements during total hiparthroplasty[J].Lancet,1996,347(8997):289-293.
[108]Anttila V,Hagino I,Zurakowski D,et al.Higher bypass temperature correlates with increased white cell activation in the cerebral microcirculation[J].JThorac Cardiovasc Surg,2004,127(6):1781-1788.
[109]Corbett D,Thornhill J.Temperature modulation(hypothermic and hyperthermic conditions)and its influence on histological and behavioral outcomes following cerebral ischemia[J].Brain Patho,2000,10(1):145-152.
[110]Hennein HA,Kiziltepe U,Barst S,et al.Venous modified ultrafiltration after cardiopulmonary bypass in children:a prospective randomized study[J].J Thorae Cardiovasc Surg,1999,117:496-505.
[111]李刚,芶大明,杜磊,等.变温式改良超滤改善婴幼儿心脏手术的预后[J].中国体外循环杂志,2008,6(4):193-196.
[112]黄惠民,姚廷俊,王伟,等,连续性超滤减轻体外循环肺损伤的研究[J].上海医学,2003;26(10):742-744
[113]Sever K,Tansel T,Basaran M,et al.The benefits of continuous ultrafiltration in pediatric cardiac surgery[J].Scand Cardiovasc,2004,38(5):307-311.
[114]Aggarwal N K,Das S N,Sharma G,et al.Efficacy of combined modified and conventional ultrafiltration during cardiac surgery in children[J].Ann Card Anaesth,2007,10(1):27-33.
[115]刘高利,王安彪,李德才,等.平衡超滤联合改良超滤对婴幼儿体外循环术后肺功能的影响[J].中华小儿外科杂志,2006,27(12):625-627.
[116]Maehara T,Novak I,Elliott MJ.PerioPerative monitoring of total body water by bio-electrical impedance in children undergoing open heart surgery[J].Eur J Cardiothorac Surg,1991,5:258-265.
[117]Onoe M,Magara T,Yamamoto Y,et al.Modified ultrafiltration removes serum interleuking in adult cardiac surgery[J].Perfusion,2001,16(1)37-42.
[118]Finn A,Naik S,Klein N,et al.Interleukin-8 release and neutrophil degranulation after pediatric cardiopulmonary bypass[J].J Thorac Cardiovasc Surg,1993;105:234-239.
[119]Jouronis D,Puopard P,Greeley WJ,et al.Hemofiltration during cardiopulmonary bypass in pediatric cardiac surgery[J].Anesthesiol,1994,81:1181-1189.
[120]Wang MJ,Chiu IS.Hus CM,et al.Efficacy of ultrafiltration in removing inflammatory mediators during pediatric cardiac operations[J].Ann Thorac Surg,1996,61:651-654
[121]Friesen RH,Campbell DN,Clarke DR,et al.Modified ultrafiltration at tenuates dilutional coagulopathy in pediatric open heart operations[J].Ann Thorac Surg,1997,64:1787-1789.
[122]Naik SK,Balaji S,Elliott M.Modified ultrafiltration improves hemnodynamics after cardiopulmonary bypass in children.JACC,1992,19:37.
[123]Davies MJ,Nguyen K,GaynorJW,et al.Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass[J].J Thorac Cardiovase Surg,1998,115:361-369.
[124]Bando K,Vijay P,Turrentine MW,et al.Dilutional and modified ultrafiltration reduces pulmonary hypertension after operations for congenital heart disease:a prospective randomized study[J].J Thorac Cardiovase Surg,1998,115:517-525.
[125]Skaryak LA,Kirshbom PM,Bernardo LR,et al.Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest[J].J Thorac Cardiovase Surg,1995,109:744-752.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |