Objective To investigate the effects of exogenous pulmonary surfactant （PS） on ventilation weaning and respiratory mechanics in infants with acute lung injury（ALI） after cardiopulmonary bypass （CPB）.Methods Twelve infants underwent cardiopulmonary bypass cardiac surgery committed with ALI and difficulty in weaning from ventilation were included in this study.Exogenous PS was used in the treatment via intra-tracheal administration.The changes of blood gas，respiratory mechanics and the conditions of ventilation weaning were observed.Results After intra-tracheal PS administration，spontaneous breath remained steady；spontaneous respiratory rate significantly decreased from，tidal volume of spontaneous breath increased significantly.Three concave sign disappeared and koilosternia was alleviated.PaCO2 value decreased significantly and peak inspiratory pressure（PIP） decreased from （36.18±10.25）cm H2O to （25.11±5.14）cm H2O （Plt;0.01）.Static lung compliance （Cstat） increased from （1.49±0.65）mL·cm H2O-1·kg-1 before treatment to （1.95±0.50） mL·cm H2O-1·kg-1 6 h after treatment （Plt;0.01）；and airway resistance （Rstat）decreased from （128.17±26.34） cm H2O·L-1·s-1 before treatment to （78.56±18.22） cm H2O·L-1·s-1 6 h after treatment （Plt;0.01）.All 12 infants weaned from ventilator successfully.Conclusion Combined with PS intra-tracheal treatment，lung protective ventilation strategy can significantly improve parameters of respiratory mechanics，increase dynamic lung compliance，decrease airway resistance，which can decrease the breathing effort of the infants and make it easy to wean from ventilator.
Objective To analyze the risk factors for ventilator-associated pneumonia( VAP) in adult patients undergoing cardiac surgery with cardiopulmonary bypass ( CPB) . Methods A total of 127 consecutive adult patients who received postoperative ventilation for more than 48 hours between January 2002 and June 2008 in the cardiac surgical intensive care unit( CSICU) were included in this study. The patients were assigned into a VAPgroup( n =64) and a control group( n = 63) . Pre-, intra-, and postoperative factors were collected and analyzed between two groups, and the multivariate analysis( logistic regression)were used to identify the risk factors of VAP. Results The overall incidence of VAP was 5.1%. The mortality of VAP was 28. 1% . Compared to the control group, the patients in the VAP group had longer duration of cardiopulmonary bypass time, ventilation time, more blood products usage and the duration of stay in CSICU( P lt; 0. 001) , higher morbidity of low cardiac output syndrome and tracheotomy( P lt; 0. 01) and higher rate of aortic surgery and mortality( P lt; 0. 05) . The preoperative left ventricular ejection fraction ( LVEF) and postoperative oxygenation index( PaO2 /FiO2 ) were lower in the VAP group than those of the control group( P lt; 0. 001) . Five variables were found to be significantly related to the development of VAP by multivariate analysis: CPB time gt; 120 min( OR = 6. 352, P = 0. 000) ; PaO2 /FiO2 lt; 300 mm Hg( OR =3. 642, P = 0. 017) , transfusion of blood products ≥1500 mL( OR = 5. 083, P = 0. 039) , ventilation time≥5 days( OR = 9. 074, P = 0. 047) and tracheotomy( OR = 19. 899, P = 0. 021) . A total of 102 pathogens were obtained by sputum culture in 64 VAP patients. There were 62( 60. 8% ) cases of gram negative bacilli, 19 cases( 18. 6% ) of gram positive cocci and 21( 20. 6% ) cases of eumycetes. Conclusion This study shows that the cardiopulmonary bypass time, ventilation time, hypoxemia, blood products transfusion and tracheotomy are risk factors most likely associated with VAP development.
Objective To study the protective effects of ulinastatin( UTI) on lung function after cardiopulmonary bypass( CPB) . Methods 42 Patients, ASA score Ⅱ ～Ⅲ, scheduled for elective cardiac valve replacement, were randomly allocated into three groups, ie. a control group, a low dose UTI group( UTI 8000U/kg) , and a high dose UTI group( UTI 12 000 U/kg) . Inspiratory pressure( PIP) , Plateau pressure ( Pplat) , alveolar-arterial oxygen pressure difference ( AaDO2 ) , static lung compliance ( Cs) and dynamic lung compliance ( Cd) were recorded before operation ( T1 ) and at 1 hour ( T2 ) , 4 hours ( T3 ) , 24 hours ( T4 ) after CPB termination. Results Compared with pre-CPB, postoperative PIP, Pplat and AaDO2 increased, and Cs and Cd decreased significantly in the control group( all P lt; 0. 05) . Compared with the control group at T2 ～T3 , postoperative PIP, Pplat, AaDO2 were significantly lower( P lt;0. 05) , and Cs and Cd were significantly higher in the two UTI groups( P lt;0. 05) . Compared with the low dose UTI group at T2 ～T3 , the PIP, Pplat and AaDO2 were significantly reduced( P lt;0. 05) , and the Cs and Cd were significantly increased in the high dose UTI group( P lt; 0. 05) . Conclusion UTI can alleviate lung injury and improve lung function during valve replacement surgery with CPB in a dose dependent manner.
Objective To investigate the trends of cardiopulmonary bypass （CPB） professional development and personnel constitution in the past five years in China， and provide prediction and advice for the trend of Chinese CPB personnel constitution in the future. Methods We conducted 2 questionnaire investigations of Chinese hospitals in which cardiovascular surgeries were performed in the year 2005 and 2010， regarding the number of on-pump and off-pump cardiovascular operations and cases of extracorporeal membrane oxygenation （ECMO）. Data of CPB personnel constitution in the year 2005 and 2010 were analyzed. Results The total number of cardiovascular operation， on-pump cardiovascular operation and ECMO cases was 104 631， 86 155， and 68 respectively in 2005. The total number of cardiovascular operation， on-pump cardiovascular operation and ECMO cases was 170 547， 136 753， and 206 respectively in 2010. There were 708 CPB professionals in 2005， including 40.2% （285/708）full time perfusionists and 23.2% （164/708）perfusionists with senior professional titles. There were 2 111 CPB professionals in 2010， including 37.6% （793/2 111） full time perfusionists and 25.5% （539/2 111） perfusionists with senior professional titles. Conclusion There has been a rapid CPB professional development in the past five years in China. The proportion of full time perfusionists， perfusionists with senior professional titles and higher educational degree will further increase in the future.
Objective To compare the graft patency rates of conventional on-pump coronary artery bypass grafting （CCABG） and off-pump coronary artery bypass grafting （OPCAB） at 2 weeks，3 months and 1 year after surgery. Methods Clinical data of 200 patients who underwent coronary artery bypass grafting （CABG） in the First Affiliated Hospital of Harbin Medical University from May 2010 to November 2011 were retrospectively analyzed. All the 200 patients were divided into two groups according to different surgical procedures they received：CCABG group，61 patients including 32 male patients and 29 female patients with their age of 59.8±4.7 years；and OPCAB group，139 patients including 72 male patients and 67 female patients with their age of 59.6±8.9 years. Graft patency of all the patients was evaluated by 256-slice multislice computed tomography angiography （256-MSCTA） at 2 weeks，3 months and 1 year after CABG and compared between two groups. Results At 2 weeks，3 months and 1 year after CABG，the graft patency rates of left internal mammary artery （LIMA） grafting were not statistically different between CCABG group and OPCAB group，as well as those of great saphenous vein （GSV） grafting （P＞0.05）. The 1 year graft patency rates of LIMA grafting of CCABG group and OPCAB group were 92.31% and 91.94% respectively，and 1 year graft patency rates of GSV grafting of CCABG group and OPCAB group were 91.35% and 90.00% respectively. To compare the graft patency rates of different distal anastomotic locations，grafting to the left anterior descending （LAD） coronary artery had significantly higher patency rate than grafting to the right coronary artery （RCA，P＜0.05）. The 1 year graft patency rates of LAD grafting and RCA grafting were 97.78% and 85.90% respectively. But there was no statistical difference in graft patency rates at different respective distal anastomotic locations between OPCAB group and CCABG group （P＞0.05）. To compare early clinical outcomes of two groups，postoperative mechanical ventilation time，length of ICU stay，24-hour mediastinal drainage，24-hour blood transfusion，length of hospital stay，and hospitalization cost of OPCAB group were significantly shorter or lower than those of CCABG group （P＜0.05）. Conclusion Short-term graft patency rates of CCABG and OPCAB are quite similar. Patency rate of grafting to LAD is higher than that of grafting to RCA. OPCAB can produce better perioperative clinical outcomes than CCABG.
Objective To introduce a novel approach using parallel placement of another oxygenator in the recirculation line as oxygen supply for oxygenator failure without circulatory arrest in cardiopulmonary bypass （CPB），and confirm its outcomes in an animal experiment. Methods A traditional piglet CPB model was established. Oxygenator failure model was established by reducing fraction of inspired oxygen （FiO2） from 80% to 21% after aortic cross-clamp and cardiac arrest in CPB. Another oxygenator was then parallel placed in the recirculation line to supply 100% oxygen.Dynamic changes in partial pressure of oxygen （PaO2），mixed venous oxygen saturation （SvO2），arterial oxygen saturation（SaO2） and blood pH of blood samples from the arterial perfusion duct were monitored with different blood flow of400 ml/min，800 ml/min and 1 100 ml/min. Results When FiO2 was reduced to 21%，PaO2 decreased to 64-67 mm Hg（P＜0.001），SaO2 decreased significantly to 88%-90% （P＜0.001），SvO2 decreased to 69%-72% （P＜0.001），and blood pH decreased too，all indicating oxygenator failure. After parallel placement of another oxygenator in the recirculation line was performed，PaO2，SaO2 and SvO2 all significantly increased，as well as blood pH. When the blood flow in the recirculation line achieved 33% or above of overall arterial perfusion flow，clinical oxygen demand was generally satisfied. Conclusion Parallel placement of another oxygenator in the recirculation line may be utilized as a treatment strategy for oxygenator failure without circulatory arrest and changeover of failed oxygenator.
Abstract： Objective To observe myocardial protective effect of sevoflurane used in the whole process of cardiopulmonary bypass（CPB）. Methods A total of 150 patients older than 18 years who underwent cardiac surgery under CPB in Fu wai Hospital from January 2010 to November 2011 were enrolled in this double-blind and randomized controlled study. All the patients were randomly divided into three groups：Sevoflurane pretreatment group （Group A，n=50），whole-process Sevoflurane group （Group B，n=50），and whole-process intravenous anesthesia group （Group C，n=50）. Radial artery pressure and other hemodynamic parameters were continuously measured for all the patients. At following time points: CPB beginning （T1），aortic declamping （T2），3 hours after aortic declamping （T3），and 24 hours after aortic declamping （T4），serum concentrations of cardiac troponin I （cTnI） and other parameters were measured by enzyme-linked immunosorbent assay （ELISA）. Results There were 31 males and 19 females at age of 60.43±3.24 years in group A，28 males and 22 females at age of 59.88±4.12 years in group B，31 males and 19 females at age of 58.76±3.87 years. There was no statistical difference in mean arterial pressure （MAP），central venous pressure （CVP），pulmonary artery wedge pressure （PAWP） and heart rate （HR） at respective time points among the 3 groups （P＞0.05）. At T1 and T2，there was no statistical difference in cardiac index （CI） among the 3 groups （P＞0.05）. At T3，there was no statistical difference in CI between Group A and Group C（F=3.382，P=0.845），but CI of Group B was significantly higher than that of Group A and C（F=3.382，3.382； P=0.033，0.020）. At T4，CI of Group B was significantly higher than that of Group A and C （F=13.324，13.324； P=0.005，P=0.000），and CI of Group A was significantly higher than that of Group C （F=13.324，P=0.024）. At T1 and T2，there was no statistical difference in serum concentrations of creatinine kinase MB （CK-MB），cTnI，interleukin-6 （IL-6） and tumor necrosis factor alpha （TNF-α） among the 3 groups （P＞0.05）. At T3 and T4，serum concentrations of CK-MB，TNF-α，IL-6 and cTnI of Group C were significantly higher than those of Group A，and serum concentrations of CK-MB，TNF-α，IL-6 and cTnI of Group A were significantly higher than those of Group B （F=531.616，5.410，3.5813，3.160，1.126，4.702，7.819，5.424，all P=0.000）. Conclusion Sevoflurane used in the whole process of CPB has definite myocardial protective effect which is ber than that of Sevoflurane pretreatment.
Objective To investigate the impact of different modes of cardiopulmonary bypass （CPB） and cerebral perfusion on cerebral protection in patients with Stanford type A aortic dissection （AD）. Methods Clinical data of 117 patients with Stanford type A AD who underwent surgical therapy from April 2007 to March 2012 in the First Affiliated Hospital of Harbin Medical University were retrospectively analyzed. All the patients were divided into 3 groups according to different modes of CPB and cerebral perfusion they received. In group 1，45 patients received CPB perfusion through the femoral artery and unilateral or bilateral antegrade selective cerebral perfusion （ASCP） after circulatory arrest. In group 2，38 patients received CPB perfusion through the subclavian artery or innominate artery and unilateral or bilateral ASCP after circulatory arrest. In group 3，34 patients received antegrade and retrograde CPB perfusion through both subclavian artery or innominate artery and femoral artery，and unilateral or bilateral ASCP after circulatory arrest. Postoperative occurrence of transient neurological dysfunction （TND），permanent neurological dysfunction （PND） and influential factors were compared between the 3 groups. Results Incidence of postoperative cerebral complications of group 1 was significantly higher than those of group 2 and 3 （37.77% vs. 13.16% vs. 14.71%，P ＜0.05）. During CPB，cooling time of group 3 was significantly shorter than those of group 1 and 2 （35.56±4.35 vs. 40.00±5.63 and 39.58±6.03，P ＜0.05）. There was no statisticaldifference in other influential factors among the 3 groups （P ＞0.05）. Conclusion Antegrade and retrograde CPB perfusionin combination with ASCP has a smooth and quicker cooling rate，may provide better protection for the spinal cord，kidney and intraperitoneal organs and especially decrease the incidence of postoperative cerebral complications，therefore is proved current best method for organ protection.
Abstract： Objective To explore the feasibility of using protamine-agarose gel to achieve heparin-free cardiopulmonary bypass （CPB）. Methods A total of 12 healthy adult dogs were chosen, the dogs were between 2-3 years old,either male or female, with their mean body weight of 23.3±3.7 kg （ranging from 20 to 28 kg）. All the dogs were randomly divided into two groups with 6 dogs in each group. In the heparinized group, conventional CPB technique was used; in the non-heparinized group, protamine-agarose gel column was used to absorb plasma clotting factors in CPB without use of heparin. At the beginning of CPB and 1 h, 2 h, 3 h after CPB, arterial blood samples were collected from dogs in both groups. The expression levels of tumor necrosis factor-α （TNF-α）, interleukin-6 （IL-6） and interleukin-8 （IL-8） were measured by enzyme-linked immunosorbent assay（ELISA）and compared. Results There was no thrombus formation in the membrane oxygenators during CPB by naked eye observation in both groups. Activated coagulation time （ACT） was always greater than 480 s during CPB. The vital signs of the dogs were all stable during CPB. At the beginning of CPB, there was no statistical difference in plasma concentrations of TNF-α, IL-6, IL-8 between the two groups. At 1 h, 2 h and 3 h after CPB, the expression levels of TNF-α and IL-8 of the non-heparinized group were significantly higher than those of the heparinized group （CPB 3 h TNF-α：156.48±16.65 ng/L vs. 115.87±15.63 ng/L, t=4.356, P=0.001；CPB 3 h IL-8：365.38±46.18 ng/L vs. 299.29±34.50 ng/L, t=2.808, P=0.019）. There was no statistical difference in the expression level of IL-6 between the two groups （P＞0.05）. Conclusion Using protamine-agarose gel to absorb plasma clotting factors is an effective technique to establish heparin-free CPB. But this method can induce significant systemic inflammatory response.
Abstract： Objective To investigate the effect of salvianolate on myocardium against ischemiareperfusion injury (IRI) in valve replacement with cardiopulmonary bypass (CPB), its outcome and mechanism, and the applicability and safety of salvianolate as a protection agent for CPB central muscles. Methods Thirty patients undergoing cardiac valve replacement were randomly divided into two groups by lot. In the control group, there were 15 patients including 5 males and 10 females, while in the 15 patients in the trial group, 7 were male and 8 were female. Salvianolate of 200 mg was given to the patients in the trial group intravenously. Hemodynamic parameters, blood gas analysis results, recovery of heartbeat, the dosage of dopamine used, and assisted ventilation time were recorded for both groups before aorta clamping, 2 h, 8 h, and 24 h after aorta declamping. Besides, ICU detention time, the amount of urine in 24 hours, and the amount of drainage in 24 hours after operation were also recorded. Blood samples were taken to determine serum cardial troponin I(cTnI), creatine kinase MB isoenzyme (CK-MB), malondialdehude (MDA), and superoxide dismutase (SOD) in both groups respectively at different times including after the induction of anesthesia, aorta opening, termination of CPB, end of operation, and one day after operation. Results There was no significant difference in hemodynamic parameters, the dosage of dopamine used, spontaneous recovery of heartbeat, and the amount of urine in 24 hours and drainage after operation for 24 hours between the two groups (Pgt;0.05). The rate of ventricular rhythm, blood lactic acid level, the time of assisted ventilation and ICU detention time for the trial group were significantly lower than those for the control group (Plt;0.05), while partial pressure of oxygen in artery(PaO2) was significantly lower in the trial group 8 h after aorta declamping (Plt;0.05). The levels of serum CK-MB, cTnI, and MDA after operation for both groups were higher than those before operation; and those levels for the trial group were significantly lower than the control group at various time points (Plt;0.05). The concentration of SOD decreased after operation in both groups (Plt;0.05), and it was higher in the trial group than the control group at different time points. The decrease of SOD level in the trial group was less than that in the control group. Conclusion Salvianolate can protect myocardium from ischemiareperfusion injury in cardiac valve replacement with CPB effectively, through promoting the activity of antioxidative enzymes and eliminating oxygen free radicals. Patients can be treated with salvianolate for antimyocardial ischemia reperfusion injury.