体外循环中平衡超滤对肾功能的影响

Effect of fluid balance ultrafiltration on renal function during extracorporeal circulation

目的探讨体外循环(ECC)中平衡超滤对肾功能的影响。方法选取行ECC下心脏直视手术患者45例,随机分成三组:无超滤组(C组)、常规超滤组(CUF组)和平衡超滤组(BUF组),每组各15例。分别观察术前、ECC前、ECC 20min 、60 min 、术毕、术后24 h及48 h血尿素氮(BUN)、肌酐(Cr)等肾功能指标。结果三组患者其血Cr、BUN等肾功能指标,自ECC 20 min 即开始呈现大幅度的快速升高(三组上升幅度基本一致),ECC 60 min 、术毕呈现不同幅度的升高(BUF组<CUF组<C组),术后24 h达到顶峰值(BUF组<CUF组<C组),48 h BUN值呈现不同幅度的下降(CUF组>BUF组>C组),48 h Cr值呈现不同变化趋势(BUF组↓CUF组↑C组↑)。BUF组BUN值术后24 h、48 h明显低于C组(P<0.05)有统计学意义,低于CUF组但无显著性差异;BUF组Cr值术后48 h明显低于C组(P<0.05)有统计学意义,低于CUF组但无显著性差异。结论平衡超滤技术对ECC术后的肾脏有保护作用,有助于促进肾功能尽早恢复,其保护作用优于常规超滤。

OBJECTIVE To observe the effect of fluid balance ultrafiltration（BUF） on renal function during extracorporeal circulation（ECC）.METHODS 45 patients underwent cardiac surgery with ECC were randomized to three groups.A group： fluid balance ultrafiltration（BUF,15 patients）,B group： conventional ultrafiltration（CUF,15 patients）,C group： no ultrafiltration（C,15 patients）.Blood urea nitrogen（BUN） and blood creatinine（Cr） were measured at pre-operation,before ECC,20 minutes after ECC,60 minutes after ECC,termination of operation,24 hours and 48 hours after operation.RESULTS Rapid increases（with proximate levels） of BUN and Cr were detected in all groups at 20 min after the beginning of ECC.Progressive increases with various levels were showed at ECC-60 min,at the end of the operation and reached their summits at the 24 th hour postoperatively（BUFCUFC）.BUN at the 48 th hour postoperatively decreased to different levels（CUFBUFC）,and while Cr of the 48 th hour postoperatively showed various results（BUF group↓CUF group↑C group↑）.BUN in group BUF was lower than that in group C（P〈0.05） and group CUF（P〉0.05） at the 24 th hour and the 48 th hour postoperatively.Comparison of Cr value showed the same results.CONCLUSION BUF can protect kidneys of patients undergoing cardiac surgery with ECC,benefit to the patients with renal dysfunction,and its protective effect is better than that of CUF.