搏动灌注和非搏动灌注对肾功能的影响

摘要

OBJECTIVE To observe the influence of pulsatile perfusion ( PP ) and non - pulsatile perfusion ( NPP ) on renal function in patients underwent cardiopulmonary bypass ( CPB ). METHODS Sixty low risk patients underwent CPB were divided in a double - blind and randomized fashion into 2 groups ( n = 30 each ): NPP group and PP group. In PP group, a twin pulse life support was used and the pulsatile flow was performed during the period of aortic cross -clamping. In NPP group, the non -pulsatile flow was used during CPB. In both groups, pump flow was set to 2.3 -2.8 L/( min · m2 ). Blood and urine samples were taken for determination the concentration of serum creatinine ( Scr ), blood urea nitrogen ( BUN ), plasma β2 - microglobulin ( β2 - MG ) and urinary β2 - MG before CPB ( T1 ), and 2 h ( T2 ), 12 h ( T3 ), 24 h ( T4 ), 48 h ( T5 ) after cessation of CPB. Plasma β2 - MG and urinary β2 - MG were estimated by enzyme - linked immunoadsordent assay ( ELISA ). RESULTS The two groups were comparable with respect to age, sex, stature, body weight, ejection fraction, accompanying diseases, operation type, the caliber of the arterial cannula,duration of CPB and aortic cross - clamping time. The concentrations of Scr and BUN at T4 - T5 and the concentrations of plasma β2 -MG and urinary β2 - MG at T2 - T5 were significantly increased comparing to the baseline values at T1 in both groups ( P ＜ 0.05 ).The concentrations of Scr and BUN at T4 - T5 and plasma β2 - MG and urinary β2 - MG at T2 - T5 were significantly lower in PP group than in NPP group ( P ＜ 0.05 ). CONCLUSION Pulsatile perfusion can reduce the injury of the renal tissues and suppress the decreasing degree of renal function.%目的 研究体外循环(CPB)时应用搏动灌注(PP)和非搏动灌注(NPP)对患者术后肾功能的影响.方法 拟行CPB的患者60例,采用随机、双盲的方法分为搏动灌注组(PP组)和非搏动灌注组(NPP组),每组30例.PP组在人工心肺机泵后串联双搏动式心肺辅助装置,在主动脉阻断期间采用搏动灌注.NPP组全程均采用非搏动灌注.两组灌流量控制在2.3～2.8 L/(min·m2).分别于术前(T1)、CPB后4 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)抽取外周静脉血及留取新鲜尿液,测定血清肌酐(Scr)、血清尿素氮(BUN)、血清β2-微球蛋白(β2-MG)和尿β2-MG浓度.结果 两组患者一般资料差异无统计学意义.与T1比较,两组血清Scr、BUN浓度在T4～T5明显升高(P<0.01);血清β2-MG、尿β2-MG浓度在T2～T5明显升高(P<0.05).与NPP组比较,PP组血清Scr、BUN浓度在T4～T5明显降低(P<0.05);血清β2-MG、尿β2-MG浓度在T2～T5明显降低(P<0.05).结论 PP能有效地减轻CPB后肾脏损伤,降低肾功能损害的程度.