The basis of cardiac surgery technologies is to ensure maximum efficiency in the surgical treatment of cardiovascular diseases. The quality of which is largely determined by the nature of cardiopulmonary bypass (perfusion, bypass) without which it is impossible to perform a number of surgical interventions on the heart. Despite the improvement of extracorporeal technologies, cardiopulmonary bypass (CPB) continues to be the cause of homeostasis due to the non-physiological nature of perfusion.
An ambiguous approach to the use of solutions during CPB, a few of materials on the energy deficiency of cells during perfusion, the lack of a reasonable method of electrolyte correction, which is associated with perfusion stages, the lack of biopolymers that would completely eliminate the problem of blood contact with synthetic surfaces specified the relevance of this dissertation.
The aim of this study was to improve the cardiopulmonary bypass on the basis of experimentally confirmed improvement of biocompatibility of oxygenator circuit, use of drug with direct effect on cell energy potential, modification of prime, creation of pathogenetically sound algorithm for electrolyte correction, development of a verified protocol for cardiopulmonary bypass to minimize complications during cardiac surgery.
Objectives of the study:
1. Experimentally evaluate the possibility of creating individual nanoadaptation of the surface of the extracorporeal circuit of the oxygenator using the adaptation composition.
2. Identify the features of changes in erythrocytes during treatment of the oxygenator circuit with the adaptation composition.
3. To determine the indications, evaluate the effectiveness and develop a method of application of the drug with the active substance fructose-1,6-diphosphate in cardiac surgery with cardiopulmonary bypass.
4. Improve the prime through the use of solutions that affect the colloidal osmotic pressure, osmolarity and acid-base status of the blood.
5. To develop an algorithm for the correction of blood electrolytes during cardiopulmonary bypass, taking into account the stages of cardiac surgery.
6. Create a verified comprehensive protocol for cardiopulmonary bypass.
To solve the set tasks, the research was conducted in two stages. The study was performed in two stages. At the first stage, a series of control segments of the extracorporeal contour tubes and treated with an adaptive composition was studied. The electrophoretic study of the structure of the adaptive composition before and after treatment of the contact surface of the oxygenator circuit was also performed. In the second stage included 225 cardiac surgery patients undergoing with CPB. Patients were divided into three groups. The first group (Gr1) included patients (n = 75) who underwent CPB with the treatment of an extracorporeal circuit by adaptation composition (AdC), the second group (Gr2) included patients (n = 75) who were administered the fructose-1,6-diphosphate (PDP), the third group (Gr3) was the control (n = 75).
Before surgery, all patients underwent screening, which included assessing physical status on the scale of the American Association of Anesthesiologists (ASA), assessing heart failure according to the NYHA (New York Heart Association Functional Classification). Laboratory preoperative examination included: complete blood cell count, biochemical blood test, coagulation panel, blood phosphorus level, lipid profile, gas composition and acid-base status of the blood. Instrumental methods of diagnosis were: ECG, fibrogastroduodenoscopy, chest radiography, doppler examination.
The groups were statistically equable and had no significant differences by sex, age, body surface area, functional class (p> 0.05 for each parameter).
Examination of patients before surgery was divided into 4 periods: at 10 min. CPB-time (cooling stage of the patient), at 60 min. CPB-time (rewarming stage) and after CPB.
All patients received standard premedication with diazepam. Before and after CРВ maintenance of anesthesia with sevoflurane inhalation anesthetic (low flow), during CPB anesthesia was used the infusion of propofol.
