Pediatrik Kardiyopulmoner Kalp Ameliyatlarında Pulsatil ve Pulsatil Olmayan Perfüzyonun Oksijenatör Fiberleri Üzerindeki Etkileri

Açık kalp ameliyatlarında hastalar pulslu ve pulssuz olmak üzere iki şekilde perfüze edilebilmektedir. Pulslu akışın, pulssuz akışa göre sahip olduğu yüksek enerjinin hastaya ve oksijenatör fiberine farklı etkileri olabilmektedir. Özellikle pulslu perfüzyon tipinin oksijenatör fiberleri üzerine etkileri tam olarak bilinmemektedir. Çalışmanın amacı pulslu ve pulssuz perfüzyonun oksijenatör fiberleri üzerine etkilerinin araştırılmasıdır. Pediatrik açık kalp ameliyatı geçiren 32 hastadan 18’i uygun aortik çapraz kıskaç sürelerine göre seçilerek çalışmaya dahil edilmiştir. 18 hastadan 9 çocuk hastaya pulslu, 9 çocuk hastaya pulssuz perfüzyon uygulanmıştır. Kardiyopulmoner bypas öncesi (T1), aorta çapraz kıskaç ile kapatıldığında (T2) ve açıldığında (T3), yoğun bakım 1. Saatte (T4) ve 24. Saatte (T5) olmak üzere 5 ayrı zaman diliminde tam kan ve plazma proteinleri ölçümlerinin karşılaştırılması için hasta kanları toplanmıştır. Açık kalp ameliyatı sonlandığında ve hastanın yaşamsal belirtileri sabitlendiğinde, kullanılan vücut dışı dolaşım devresinde oksijenatör çıkartılmış, fiber bölgesinden 10 cm’lik fiber parçaları alınarak PBS çözeltisine konmuştur. Fiberlerin bulunduğu bu çözeltide tazelenen ve sonikasyon işlemine tabi tutulan yeni çözeltide tam kan ve mikro-protein ölçümleri yapılmıştır. Hasta sonuçlarına göre pulslu perfüzyonun kan hücrelerine ve plazma proteinlerine olumsuz bir etkisi görülmemiştir. Fiber sonuçlarına bakıldığında sonike edilmiş fiberlerde pulssuz grupta bir miktar daha fazla eritrosit, lökosit ve total protein yüzeye tutunması tespit edilmiştir. Pulslu perfüzyon daha iyi kan uyumluluğu sağlamıştır ve sahip olduğu yüksek enerjiyle daha iyi mikrodolaşım yaratmıştır.

Anahtar Kelimeler:

Pediatrik Kardiyopulmoner Bypass, Ekstrakorporal dolaşım, Pulslu Perfüzyon, Pulssuz Perfüzyon, Biyouyumluluk, Kan uyumluluğu

Effects of Pulsatile and Non-Pulsatile Perfusion On Oxygenator Fibers During Pediatric Cardiopulmonary Bypass

In cardiopulmoner operations patients can be perfused with a pulsatile or nonpulsatile pump mode. The extra energy maintained by the pulsatile perfusion may have different effects on the patient and the oxygenator fiber rather than nonpulsatile perfusion. Especially the effect of pulsatile perfusion on the fibers isn’t clearly known. The purpose of this study is to investigate the effects of pulsatile and non-pulsatile blood flows on oxygenator fibers. 18 out of 32 patients that had an pediatric open heart surgery was chosen according to their aortic clamp times. 9 of 18 patients were perfused in a pulsatile mode, other 9 patients were perfused in a nonpulsatile mode. The patient blood was collected before the open heart surgery (T1), before aortic clamp (T2), after aortic clamp (T3), after 1st intensive care hour (T4) and after the 1st intensive care day (T5) in order to compare the results of whole blood and plasma proteins. At the end of the open heart operation 10 cm of oxygenator fiber was removed from the fiber bundle and taken into the phosfate buffer saline (PBS) solution after the patient had a stabile outcome. Whole blood and micro protein measurements were applied in both first fiber solution and sonicated solution. No harmful effect of pulsatile perfusion on blood cells and proteins was observed according to patient results. More blood cell aggregation and total protein adsorption was observed in nonpulsatile mode fibers results. In this study pulsatile perfusion maintained better blood compability over nonpulsatile perfusion and the extra energy in pulsatile perfusion caused better microcirculation.

Keywords:

Pediatric Cardiopulmonary Bypass, Extracorporeal circulation, Pulsatile Perfusion, Nonpulsatile Perfusion, Biocompability, Hemacompability,

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