复合超滤对小儿先心病术后心功能的影响

摘要

Objective To study the clinical evaluation of using compound ultrafiltration on effect of postoperative cardiac function of infants with Congenital Heart Diseases under ECC. Methods 60 patients who underwent ventrieular septal defect (VSD) repaired were randomly divided into four group:conventional ultrafiltration group( CUF, n= 15 ), modified ultrafiltration group( MUF, n= 15 )、 zero-balanced ultrafiltration group (ZUF, n= 15 ) and modified ultrafiltration+zero-balaneed ultrafiltration group ( M +Z, n= 15 ). The patient's time of mechanical ventilation ( MAT)、 Cardiac index ( CI ) and the concentrations of tumor necrosis factor (TNF-α) and interleukin-8 (IL-8) in the four groups were respectively monitored. Results After operation, the time of mechanical ventilation in M+Z group was shorter than that in the other groups;At 2、12、24 and 48h after operations the CI in M+Z group was higher than in the other groups (P＜0. 05 ) ;At 2、12、24 and 48h after operations ,The concentrations of TNF-α and IL-8 in M+Z group and ZUF group was lower significantly than that in the MUF group and CUF group( P＜0. 05 ). Conclusion Compound ultrafiltration can decrease better the body's concentrations of inflammatory response,improve Cardiac index ( CI) and cardiac function of postoperative infants with congenital heart diseases.%目的 探讨应用复合超滤技术对改善小儿先心病体外循环(extracoporeal circulation,ECC)术后心功能的临床效果.方法 60例行室间隔缺损(VSD)修补术的患儿随机分为4组:常规超滤组(CUF组,n=15)、改良超滤组(MUF组,n=15)、零平衡超滤组(ZUF组,n=15)和改良超滤+零平衡超滤组(M+Z组,n=15).分别检测各组围术期呼吸机辅助时间(MAT)、心脏指数(CI)及炎性介质肿瘤坏死因子-α(TNF-α)和白细胞介素-8(IL-8)的浓度.结果 术后M+Z组呼吸机支持时间较其他3组短(P＜0.05);M+Z组术后2、12、24、48h心脏指数(CI)较其他3组高(P＜0.05);M+Z组和ZUF组术后2、12、24、48h TNF-α和IL-8浓度较MUF组和CUF组明显降低(P＜0.05).结论 复合超滤能更好地降低体内炎性介质浓度,提高心脏指数(CI),改善小儿先心病惠儿术后心功能.