Dissertation
Dissertation > Medicine, health > Pediatrics > Pediatric surgery > Pediatric surgery and surgical

Effects of Ultrafiltration on Blood Rheology in Infants during Cardiopulmonary Bypass

Author NiuWei
Tutor ZhangHong
School Zunyi Medical College,
Course Anesthesiology
Keywords Cardiopulmonary bypass Ultrafiltration Hemorheology Infant
CLC R726.1
Type Master's thesis
Year 2011
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Objective:To evaluate the effects of ultrafiltration on hemorheology in infants during Cardiopulmonary Bypass.Methods:26 patients received intracardiac operation underdirect vision and cardiopulmonary bypass(CPB) were studied.patients were randomly divided into two groups:conventional ultrafiltration (CUF) group (C group,n=13) and Without-ultrafilt-ration group (W group,n=13). W group did without ultrafiltration during cardiopul-monary bypass, while C group started with conventional ultrafiltration at rewarming to 33℃, flow rate of CUF ranged 10-15ml·kg-1·min-1, CUF lasted for 8-10 minutes. Arterial blood samples were repeatedly collected at the following time:Before transfer (T1), blocking the ascending aorta 10min (T2) in CPB, C group at ultrafiltration time/W group at rewarming to 33℃(T3), at the end of CPB (T4),24h (T5) and 36h after operation (T6).5ml of arterial blood was collected with hepathrom test-tube. To observe and detect by SOUTH990 BZ completely auto-maticdual path ways at (37±1)℃. we recorded the changes of relative indexes of clinical data and cardiopulmonary bypass; Patients followed up were recorded the hospital days, ICU days, ventilation time, time of ventilator withdrawal, total blood transfusion, drainage volume, urine in each group.Result: 1. Clinical data and cardiopulmonary bypasss results:Cardiac of patients of two groups could auto-resuscited successful after the opening the ascending aorta and no one case of perioperation was death; Volumes pre-filled type, time of CPB, blocking the ascending aorta, and other relative indexes were no significant difference in two groups.2. Hemorheology: Between time and the ultrafiltration were no interaction in two groups of children and the trends were not completely parallel (P>0.05).①Plasma viscosity: The plasma viscosity was no significant difference between two groups of patients before transfer (P>0.05); Comparison of group repetition effects:At the begining of CPB, T3, T4 were significantly lower than T1 about plasma viscosity (P<0.05), T5, T6 compared with T1 about the plasma viscosity was no significant difference (P>0.05); Comparison between the effect of group: Ultrafiltration had no effect on the plasma viscosity between two groups (P>0.05);②Erythrocyte rigidity index (IR):Red cell rigidity index of two groups was no significant difference before transfer (P>0.05); Comparison of group repetition effects: At the begining of CPB, Comparison the IR of two groups of children with T2 and T1 was significantly reduced (P<0.05); IR at T5, T6was significantly higher than one at T1 (P<0.05). The IR at the T4, T5, T6 was significantly higher than one at T3 in C group; Comparison between the effect of group:Ultrafiltration had no significant effect on the IR between two groups (P>0.05);③RBC deformation index(TK):RBC deformation index of two groups of children was no significant difference before transfer (P>0.05); Comparison of group repetition effects:At the begining of CPB, comparison of two groups of children with T2 and T1, TK decreased significantly (P<0.05); At the other time points, TK of two groups no significant difference than those at T1 (P>0.05); Comparison between the effect of group:Ultrafiltration had no significant effect on the TK between two groups (P>0.05);④RBC aggregation index (Agrbc):Red cell aggregation index of two groups of children was no significant difference before transfer (P>0.05); Comparison of group repetition effects:At the begining of CPB, comparison of two groups of children with T3 and T1 decreased significantly (P<0.05); The agrbc at T5, T6 was significantly higher than one at T1 (P<0.05). The agric at T4, T5, T6 was significantly higher than one at T3 (P<0.05). Comparison between the effect of group:Ultrafiltration had no significant effect on the agrbc between two groups (P>0.05);⑤Hematocrit (Hct):Hematocrit of the two groups of children had no significant difference before transfer (P>0.05). Comparison of group repetition effects:At the begining of CPB, Hct at T2, T3 was significantly lower than one at T1 (P<0.05), and Hct at T5, T6 was significantly higher than one at T1 (P<0.05); Comparison between the effect of group:Hct of the ultrafiltration group at T4, T5, T6 was significantly higher than one of no-ultrafiltration at T3 (P<0.05);⑥Fibrinogen (Fib):Fibrinogen of the two groups of children had no significant difference before transfer (P>0.05). Comparison of group repetition effects:At the begining of CPB, The Fib at T2, T3, T4 was decreased significantly than one at T1 (P<0.05), The Fib at T5, T6 compared with at T1 was increased significantly (P<0.05); Comparison between the effect of group:Ultrafiltration had no significant effect on the fib between two groups (P>0.05).3. Postoperative follow-up results:ICU days, ventilation time, time of ventilator withdrawal, drainage volume of Ultrafiltration group were less than those of non-ultrafiltration group, others were no significant difference between the two groups (P<0.05).Conclusions:Application of ultrafiltration in infants can rapidly increase the hematocrit levels during CPB, also can reduce postoperative edema of various organs, diminish postoperative complications and postoperative bleeding, improve the recovery of the heart, lungs, and other organs and cut the postoperative patient care unit days. At the same time, It had no significant effect on the changing the line of red blood cells, while might have some impact on the aggregation of red blood cells.

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