Complex protocol of cardiopulmonary bypass

Background. Innovative advances in cardiac surgery to reduce the negative impact of cardiopulmonary bypass (CPB) require a comprehensive solution. The ultimate questions present interest remain prevention hypoxia, composition priming volume oxygenator, state erythrocytes and their energy potential, level hemolysis, pathogenetic approach correction electrolytes during perfusion, as well biocompatibility extracorporeal circuit. study aimed create protocol for bypass, which includes possibility reducing effects synthetic polymers circuit; hydrodynamic load on tissue; carrying out more physiological acid-base state; improving potential cells; electrolyte balance taking into account stages surgical operation. Materials methods. included 225 patients who underwent using bypass. were divided three groups. first group consisted 75 people, whose contour was treated with adaptive by special technique. After centrifuging patient’s blood, serum obtained, diluted solution 0.9% NaCl oxygenator second (n = 75) whom fructose-1,6-diphosphate (FPD) used perfusion regimen. drug administered intravenously at dose 10 g rate ml/min two stages: 5 FPD injected immediately before start patient warmed up. third control group. Perfusion performed membrane non-pulsating blood flow mode prime 1.3–1.6 L achieve moderate hemodilution (Ht — 25 ± 2 g/L). A hyperosmolar total osmolarity up 510.6 mmol/L used. basic solutions volutens, reosorbilact, mannitol 15%, Soda-buffer 4.2%. Hemogram (Hb, Ht, MCV, MCH, MCHC, RDWa, RDW%, hemolysis), oxygen transport: saturation arterial (SaO2%) venous (SvO2%), partial pressure (PaO2) (PvO2), delivery index (IDO2), consumption (IVO2), extraction (O2ER), (O2EI) studied. research morphological changes carried out. Results. Our develop implement practice an optimized based results obtained. previous studies have shown that treatment oxy-genator circuit creates protective layer autoalbumin inner surface circuit, use active ingredient allows correcting hypophosphatemia, deficiency cells. In these groups, comparison one, after CPB, there lower number echinocytes, spherocytes. groups volume. Before following indices: IDO2 332.00 84.84 ml/(min • m2), IVO2 76.07 28.34 O2ЕR 22.91 6.33 %, O2EI 22.47 6.32 BE –0.78 2.13 mmol/L. At min 579.7 112.3 30.91 13.31 ml / (min O2ER 5.35 2.07 5.26 2.08 0.82 2.03 increased due gas exchange, decrease IVO2, O2ЕR, can be explained cooling. warming stage, 598.8 114.9 108.10 33.11 18.04 4.14 17.95 4.15 –0.11 8.88 305.7 60.9 77.15 24.29 25.36 6.5 25.34 –0.36 2.20 diuresis 11.88 5.31 ml/kg/h, relative hydrobalance CPB 9.67 8.12 ml/kg. proposed points: 1) composition; 2) initially low phosphorus, administration scheme; 3) oxygenator; 4) surgery. Conclusions. procedure is simple affordable, improves oxygenator. avoids provides adequate transport function blood. application makes it possible hemolysis protect erythrocytes, correct operations peculiarities CPB.