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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3842_Библиотеки_им_академика_М_И_Перельмана
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Perfusion inCongenital Heart Surgery
245
mia. Yet, temperatures of 28°C in the CPB circuit may be
still employed in congenital cardiac surgery and other highly
demanding surgeries. Changes in CO2 solubility in the presence of deep hypothermia result in comparable changes in
pH, which have an effect on cerebral blood ow. The pH-stat
technique involves the injection of exogenous CO2 to compensate for its low values during hypothermia. The presence
of increased ePCO2 readings is seldom due to an oxygenator
failure, which is manifested more frequently as inadequate
blood oxygenation [34].
pH andBlood Gas Management
While conducting hypothermic CPB, blood gas management
can be assessed using either a “pH-stat” or an “alpha-stat”
technique. The principle behind the pH stat is to keep the pH
consistent at all given temperatures. CO2 must be supplied
into the oxygenator all through hypothermic CPB to maintain constant levels of pH and pCO2. On the other hand,
when using alpha-stat technique, the pH is kept at 37° C
regardless of the patient’s temperature. Alpha-stat works to
sustain normal levels of pH levels intracellulary by monitoring the natural shift of the oxyhemoglobin dissociation
curve. Because in-line blood gas analysis offers instantaneous detection of changes in air/oxygen/carbon dioxide
parameters, it is a useful technique for determining optimal
blood gas management. Numerous investigations have concluded that the pH-stat method is superior during neonatal
cardiac bypass. While cooling, this technique promotes cerebral blood ow and tissue oxygenation. Additionally, data
suggest that pH-stat control improves outcomes following
pediatric heart surgery by reducing ventilation periods and
intensive care unit stays [35].
Multiple Choice Questions
1. Extracorporeal circulation (ECC) is a term that refers to
the process of continuously withdrawing and returning a
patient’s blood through plastic tubing in order to perform
an articial organ function outside of the body’s blood
circulation. In an ECC, a variety of “articial organs” are
employed to complement a patient’s failing organs.
Articial hearts (blood pump), articial lungs (oxygenator), articial kidneys (hemodialysis), and articial livers are only a few examples of therapies that are now
available. The following is a list of the oxygenator components that should be included in the perfusion during
cardiopulmonary bypass surgery:
A. Cannula ALF and tube.
B. Cardiotomy lter and venous reservoir and lter,
ALF, tubing pack, heat exchanger.
C. Venous lter, ALF, and pump.
D. Cannula and venous reservoir.
2. Using the preceding topic, how much pressure must be
reduced in each cannula during perfusion surgery in order
for the high ow capacity be maintained?
A. Arterial pressure: 100 mmHg and venous pressure:
35–40mmHg.
B. Arterial pressure: 110 mmHg and venous pressure:
40–45mmHg.
C. Arterial pressure: 105 mmHg and venous pressure:
45–50mmHg.
D. Arterial pressure: 120 mmHg and venous pressure:
55–60mmHg.
3. During cardiopulmonary bypass, arterialized blood is
coupled with an arresting agent and other additives
obtained from a source downwards the oxygenator. Any
additive concentration can be changed to maximize
advantage. The delivery area may be cool or warm, and
the temperature uctuates throughout the arrest time.
They are used seldom in congenital cardiac surgery.
Which form of cardioplegia is this?
A. Continuous cardioplegia.
B. Cardioplegia system without the recirculation.
C. Cardioplegia system with the recirculation.
D. None.
Answers
1. B.
2. A.
3. A.
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