三种体外循环静脉管临床流量比较的研究
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摘要
随着医学的不断发展，心脏外科已经得到普遍的开展，目前全球每年约施行数十万例的心脏手术。心脏直视手术的需要促进了体外循环的产生和发展。自1951年世界首例体外循环下心脏手术在美国施行以来，人们注意到体外循环会带来许多严重后果，如血液成分的破坏、血液稀释的不良反应、血液和管道接触引发的炎症反应等，为此，医学工作者不断改进体外循环的设备和方法，尽量减轻体外循环的不良反应。
体外循环所使用的构件如血泵、氧合器、过滤器等近年来已经得到很大的改进，副作用较以前明显减轻，但作为其重要组成部分的管道结构多年来却一直没有改变，静脉回流管一直以1.27cm~2(1／2×3／32英寸)管道作为标准配置。回顾文献发现未有对其科学性和合理性进行探讨的研究。浙一医院心胸外科为达到优化体外循环管道的目的，从1996年至2001年分别使用2根0.5cm~2(3／10×1／20英寸)管道、1.0cm~2(0.44×3／32英寸)管道和1.27cm~2(1／2×3／32英寸)管道作为体外循环静脉回流管，本研究根据对体外循环记录有关数据的统计，对比分析了这三种静脉管的性能。
浙江人学颀1：学位论义
主要研究工作：1．收集1996年1月至2001年12月间使用这三种管道
的体外循环记录。2．统计病例的体重、体外循环最大流量等相关数据。3．
分析1．ocm’（0．44x3／32英寸）管道的合理性和优越性。
材料和方法
1996年1月至扣01年12月间使用这三种管道进行体外循环的病例（年
龄＞16）8门例。记录临床资料包括：性别、年龄、手术类型、体重、体
外循环最大流量和死亡例数。所有数据均在 SPSS．0统计软件包上处理。
．结果
1应用三种管道的病例组体重无明显差异（尸＞0刀5）
2三种体外循环管道最大流量无明显差异（P＞0刀5）
3死亡患者死因和静脉管类型没有直接的关系
结论
l．ocm’（．44x3／32英寸）静脉管提供的体外循环最大流量和二根0．scm’
（3／10XI／20英寸）静脉管、l．27cm’（l／2X3／32英寸）静脉管没有显著性
差异，可以应用于绝大部分体外循环手术，而1刀cm’（0．44x3／32英寸）
静脉管在减少预充量、减轻炎症反应、改善引流和经济性方面比另外两种
管道优越。
With medicine developing , cardiac surgery has been operated extensively. At present, hundreds thousand cardiac operations were performed all over the world every year. The development of open heart surgery promoted the evolvement of cardiopulmonary bypass(CPB). In the first open heart surgery with CPB performed in America 1951, doctors found it bringing many serious results , such as the broken of blood components , the ill effect of hemodilution and the inflammatory reaction caused by contact between blood and CPB tubes etc . Therefore , doctors have improved the equipments and methods of CPB continually to lighten it's bad influence to human body.
The components of CPB had been improved greatly , such as blood pump ,
oxygenator and filtrator etc , but the configuration of tube was no changed. 1.27cm2 ( 1/2+3/32inch) venous return tube has been used as standard configuration for many years. Reviewed literatures , we did not find studies about it's rationality and science. During 1996 to 2001 , three different diameter venous return tubes [two 0.5cm2(3/10+l/20inch), 1.0cm2(0.44+3/32inch) and 1.27cm2 (l/2+3/32inch) ] were used in CPB at Department of Cadiothoracic Surgecy, The First Affiliated Hospital, Medical College ,Zhejiang University. This study reviewed CPB records during 1996 to 2001 , analyzed and contrasted the maximal flow of three kind venous return tubes.
The main objects of this study: 1. collect CPB records during 1996 to 2001 2. evaluate dates of weight and flow by SPSS 10.0 software 3. analyze the rationality and advantage of 1.0cm2 (0.44+3/32inch) venous return tube.
Materials and methods
Three kind venous return tubes were used in 817 operations during 1996 to 2001 , all patients' age >16 years. Clinical materials include: gender , age , operation type , body weight, maximal flow and number of death. All dates were evaluated by SPSS 10.0 software.
Results
1 the weight of patients used three kind tubes have no difference (P>0.05) .
2 the maximal flow of three kind tubes have no difference (P>0.05 ) .
3 causes of death about six patients has no direct relation to tube type.
Conclusion
The maximal flow of 1.0cm2 (0.44+3/32inch) , two 0.5cm2(3/10+ l/20inch), and 1.27cm2 (1/2+3/32inch) venous return tubes have no difference. 1.0cm2
(0.44×3/32inch) tube can be used in vast majority of adult CPB , it reduce priming volume and contact area between blood and tube, improve the draiage in CPB , is a better choice to adult CPB than 1.27cm2( 1/2×3/32 inch ) tube and two 0.5cm2(3/10 ×1/20 inch) tube.
体外循环所使用的构件如血泵、氧合器、过滤器等近年来已经得到很大的改进，副作用较以前明显减轻，但作为其重要组成部分的管道结构多年来却一直没有改变，静脉回流管一直以1.27cm~2(1／2×3／32英寸)管道作为标准配置。回顾文献发现未有对其科学性和合理性进行探讨的研究。浙一医院心胸外科为达到优化体外循环管道的目的，从1996年至2001年分别使用2根0.5cm~2(3／10×1／20英寸)管道、1.0cm~2(0.44×3／32英寸)管道和1.27cm~2(1／2×3／32英寸)管道作为体外循环静脉回流管，本研究根据对体外循环记录有关数据的统计，对比分析了这三种静脉管的性能。
浙江人学颀1：学位论义
主要研究工作：1．收集1996年1月至2001年12月间使用这三种管道
的体外循环记录。2．统计病例的体重、体外循环最大流量等相关数据。3．
分析1．ocm’（0．44x3／32英寸）管道的合理性和优越性。
材料和方法
1996年1月至扣01年12月间使用这三种管道进行体外循环的病例（年
龄＞16）8门例。记录临床资料包括：性别、年龄、手术类型、体重、体
外循环最大流量和死亡例数。所有数据均在 SPSS．0统计软件包上处理。
．结果
1应用三种管道的病例组体重无明显差异（尸＞0刀5）
2三种体外循环管道最大流量无明显差异（P＞0刀5）
3死亡患者死因和静脉管类型没有直接的关系
结论
l．ocm’（．44x3／32英寸）静脉管提供的体外循环最大流量和二根0．scm’
（3／10XI／20英寸）静脉管、l．27cm’（l／2X3／32英寸）静脉管没有显著性
差异，可以应用于绝大部分体外循环手术，而1刀cm’（0．44x3／32英寸）
静脉管在减少预充量、减轻炎症反应、改善引流和经济性方面比另外两种
管道优越。
With medicine developing , cardiac surgery has been operated extensively. At present, hundreds thousand cardiac operations were performed all over the world every year. The development of open heart surgery promoted the evolvement of cardiopulmonary bypass(CPB). In the first open heart surgery with CPB performed in America 1951, doctors found it bringing many serious results , such as the broken of blood components , the ill effect of hemodilution and the inflammatory reaction caused by contact between blood and CPB tubes etc . Therefore , doctors have improved the equipments and methods of CPB continually to lighten it's bad influence to human body.
The components of CPB had been improved greatly , such as blood pump ,
oxygenator and filtrator etc , but the configuration of tube was no changed. 1.27cm2 ( 1/2+3/32inch) venous return tube has been used as standard configuration for many years. Reviewed literatures , we did not find studies about it's rationality and science. During 1996 to 2001 , three different diameter venous return tubes [two 0.5cm2(3/10+l/20inch), 1.0cm2(0.44+3/32inch) and 1.27cm2 (l/2+3/32inch) ] were used in CPB at Department of Cadiothoracic Surgecy, The First Affiliated Hospital, Medical College ,Zhejiang University. This study reviewed CPB records during 1996 to 2001 , analyzed and contrasted the maximal flow of three kind venous return tubes.
The main objects of this study: 1. collect CPB records during 1996 to 2001 2. evaluate dates of weight and flow by SPSS 10.0 software 3. analyze the rationality and advantage of 1.0cm2 (0.44+3/32inch) venous return tube.
Materials and methods
Three kind venous return tubes were used in 817 operations during 1996 to 2001 , all patients' age >16 years. Clinical materials include: gender , age , operation type , body weight, maximal flow and number of death. All dates were evaluated by SPSS 10.0 software.
Results
1 the weight of patients used three kind tubes have no difference (P>0.05) .
2 the maximal flow of three kind tubes have no difference (P>0.05 ) .
3 causes of death about six patients has no direct relation to tube type.
Conclusion
The maximal flow of 1.0cm2 (0.44+3/32inch) , two 0.5cm2(3/10+ l/20inch), and 1.27cm2 (1/2+3/32inch) venous return tubes have no difference. 1.0cm2
(0.44×3/32inch) tube can be used in vast majority of adult CPB , it reduce priming volume and contact area between blood and tube, improve the draiage in CPB , is a better choice to adult CPB than 1.27cm2( 1/2×3/32 inch ) tube and two 0.5cm2(3/10 ×1/20 inch) tube.
引文
1. Galletti PM, Brecher GA. Heart-lung bypass,principles and techniques of extracorporeal circulation.New York:Grune and Stratton ,1962.
2. Kay PH. Techniques in Extracoporeal Circulation. 3rd ed. Oxzord:Butterworth-Heinemann, 1992
3. Janse PG ,te-Velthuis H ,Bulder ER ,et al. Reduction in priming volume attenuates the hyperdynamic response after cardiopulmonary bypass. Ann Thorac Surg. 1995; 60:549-50.
4. Nelson RM. Extracorporeal circulation. In: Sabiston DC, editor. Textbook of surgery: the biological basis of modern surgical practice, 14th ed. Philadelphia, PA:Saunders, 1981 ,p, 2542.
5. Ni YM ,Leskosek B, Shi LP, et al. Optimization of venous return tubing diameter for cardiopulmonary bypass. Eur J Cardiothorac Surg , 2001; 20(3),614-20.
6. Edmunds LH jr: Inflammatory and immunological response to cardiopulmonary bypass in neonates infants and young children, Ed, janas RA, Ellioh, MJ, Butlerworth, Heinemann, pp 225-240,1994.
2. Kay PH. Techniques in Extracoporeal Circulation. 3rd ed. Oxzord:Butterworth-Heinemann, 1992
3. Janse PG ,te-Velthuis H ,Bulder ER ,et al. Reduction in priming volume attenuates the hyperdynamic response after cardiopulmonary bypass. Ann Thorac Surg. 1995; 60:549-50.
4. Nelson RM. Extracorporeal circulation. In: Sabiston DC, editor. Textbook of surgery: the biological basis of modern surgical practice, 14th ed. Philadelphia, PA:Saunders, 1981 ,p, 2542.
5. Ni YM ,Leskosek B, Shi LP, et al. Optimization of venous return tubing diameter for cardiopulmonary bypass. Eur J Cardiothorac Surg , 2001; 20(3),614-20.
6. Edmunds LH jr: Inflammatory and immunological response to cardiopulmonary bypass in neonates infants and young children, Ed, janas RA, Ellioh, MJ, Butlerworth, Heinemann, pp 225-240,1994.