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

Aim: The use of a simple, safe and convenient method of treatment extracorporeal circuit with «adaptation composition » (AdC) for the reduction of negative impact on the state of erythrocytes and tissue hypoxia. Material and methods: The research included 150 patients. They were divided into two groups. The first group included patients who underwent surgery with the treatment of an extracorporeal circuit by AdC, the second group was the control group. Сomplete blood count parameters, plasma free hemoglobin concentration, erythrocyte mechanical and osmotic resistance, erythrocyte membrane permeability and acid hemolysis were studied. Results: Use of AdC prevents adsorption the blood cells on the surface of the extracorporeal circuit and protects the erythrocytes during cardiopulmonary bypass in urgent cardiac surgery. Conclusions: The treatment of oxygenator with AdC reduces the negative influence СРВ on state of RBC. Membranes of erythrocytes were more resistant to traumatic factors in the group with AdC.

Aim. This study was aimed at developing biocompatibility of extracorporeal components due to the use of «adaptation composition» (AdC), reducing the negative impact of perfusion on the state of red blood cell due to the use of fructose-1,6-diphosphate (FDP) to decrease intraoperative hemolysis and tissue hypoxia. Material and methods. The study included 225 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The first group included patients who underwent surgery with the treatment of an extracorporeal circuit by AdC, the second group included patients who were administered the drug with the active substance FDP, the third group was the control group. The oxygenator was treated with AdC and PDF was administrated according to the protocol. Patient blood was sampling for complete blood cell count (CBC) and blood smears were at 4 stages of surgery: before CPB, at 10 min. CPB-time, at 60 min. CPB-time (rewarming stage) and after separation from CPB. Several parameters were studied: plasma free hemoglobin (plfHb), the erythrocytes osmotic, mechanical resistance of erythrocytes, erythrocyte membrane permeability (EMP), acid hemolysis, the blood smears were stained according to Pappenheim. Results. The best erythrocyte indices, hemolysis, osmotic, mechanical, acid, urea resistance of erythrocytes were observed in the groups where fructose-1,6-diphosphate and «adaptation composition» were used. At the preoperative stage, hypophosphatemia was detected in 16.8% out of 225 patients and 26.6% out of 225 patients have a clear tendency to ones. After CPB, there was no hypophosphatemia in the group where fructose-1,6-diphosphate was administered. The higher peripheralization of reticulocytes, echinocytes, and spherocytes was observed in the control group after perfusion. Conclusion. The use of AdC and FDP during CPB helps to reduce hemolysis and the better state of erythrocytes. Cardiopulmonary bypass (CPB) can negatively affect the state of red blood cell. The effect of fructose-1,6-diphosphate and «adaptation composition» on the state of erythrocytes during perfusion was studied.

The damage to erythrocytes during cardiopulmonary bypass (CPB) remains a recent problem. The aim of this research was to study the effect of fructose-1,6-diphosphate on the state of the erythrocyte membrane during CPB and the level of phosphorus in blood as a marker of the energy potential in the cell. Patients were divided into two groups. The control group 1 (Gr 1) consisted of 75 individuals. The group 2 (Gr 2) included patients to whom fructose-1,6-diphosphate (FDP) was administrated according to the developed scheme as follows 10 g of the drug was diluted in 50 ml of a solvent, 5 g of the drug was injected intravenously with the use of perfusor immediately before initiation of CPB at a rate of 10 ml/min and 5 g at the 30th minute of CPB (before the stage of warming) the same way. When comparing two groups the best results in hemolysis (p<0.01), mechanical (p<0.01). osmotic resistance of erythrocytes (p<0.01), the time of acid hemolysis (p<0.01) and the permeability of the erythrocyte membrane in postperfusion period were in Gr 2. Вefore cardiac surgery hypophosphatemia was detected in 18% out of 150 and in 32% out of 150 patients – a lower limit of normal phosphorus content in the blood. After CPB in Gr 1 phosphorus content in blood was 0.85±0.32 mmol/l and hypophosphatemia was in 53% out of 75 patients. This indicates a pronounced energy deficit in this group. In Gr 2 phosphorus level was 1.7±0.31 mmol/l and there was no hypophosphatemia. As a result, FDP as an endogenous high-energy intermediate metabolite of the glycolytic pathway leads to resistance to hemolysis, protects the erythrocyte membrane from damage and increases the energy potential of the cell during CPB.

Державна наукова установа «Науково-практичний центр профілактичної та клінічної медицини» Державного управління справами, м. Київ, Україна Застосування багатокомпонентного гіперосмолярного первинного об'єму заповнення оксигенатора при операціях на серці в умовах штучного кровообігу Резюме. Актуальність. Штучний кровообіг (ШК) справляє істотний вплив на організм пацієнтів. Першим потенційним фактором, здатним негативно впливати на функції органів і тканин під час перфузії, є первинний об'єм заповнення (ПОЗ) оксигенатора. Навіть при сучасному розвитку перфузіологічного забезпечення немає єдиного протоколу щодо того, які розчини і в якому співвідношенні необхідно використовувати в програмі первинного заповнення оксигенатора. Тому питання пошуку розчинів для заповнення контура оксигенатора дуже важливе для уникнення факторів, що спричиняють ускладнення після ШК.