复合超滤在婴幼儿体外循环中的应用

摘要

Objective To explore the application of conventional ultrafiltration (CUF) and composite modified ultrafiltration (MUF) during cardiopulmonary bypass (CPB) in infant open-heart surgery, and to investigate their influence on postoperative recovery. Methods Eighty infants receiving open-heart surgery were randomly divided into two groups: MUF (group M, n=40) and CUF+MUF (group C+M, n=40). Perioperative, CPB, and postoperative data were collected for statistical analysis, including hematocrit (Hct) and hemoglobin (Hb), priming volume, the blood transfusion volume during operation, total CPB add volume, filtrate volume, urine volume, machine residual blood volume, time of ventilator and inotrope used, ICU stay time, postoperative blood transfusion and chest tube drainage. Results The filtrate volume in group C+M was significantly more than that those in group M (P<0.05). The blood transfusion volume during operation and machine residual blood volume in group C+M were significantly less than those in group M (P<0.05); During CPB, at the end of CPB, and at the end of operation, the Hct and Hb in group C+M were significantly higher than those in group M (P<0.05). The time of ventilator and inotrope used in group C+M were significantly shorter than those in group M (P<0.05). Postoperative blood transfusion and chest tube drainage in group C+M were significantly less than those in group M (P<0.05). Conclusion Compared to MUF, CUF combined with MUF could increase the water elimination, reduce volume of blood transfusion and postoperative edema of viscera, as well as shorten the time of ventilator.%目的 探讨常规超滤(CUF)复合改良超滤(MUF)在婴幼儿体外循环(CPB)心内直视手术中的应用及对术后恢复的影响.方法 选择婴幼儿心内直视手术80 例,随机分为两组:改良超滤组(M组,n=40)、常规超滤+改良超滤组(C+M组,n=40).分析体外循环转前、转中、停机时、术毕时红细胞压积(Hct)和血红蛋白(Hb),预充总量、术中用血量、CPB中总入量、超滤量、CPB中尿量、机器余血量、CPB后血管活性药物使用时间、呼吸机辅助时间、ICU 停留时间、术后24 h 内输血量和胸腔引流量.结果 超滤量C+M组显著多于M组(P＜0.05);术中用血量、机器余血量C+M组显著少于M组(P＜0.05);Hct 和Hb在转CPB中、停CPB时和术毕时C+M组明显高于M组(P＜0.05);两组呼吸机辅助时间和血管活性药使用时间C+M组明显短于M组(P＜0.05);术后输血量和胸腔引流量C+M组明显少于M组(P＜0.05).结论 常规超滤+改良超滤的复合超滤较单纯的改良超滤能更迅速有效的排出水份,浓缩血液,减少库存血的用量,减少术后脏器水肿,缩短呼吸机辅助时间.