常规超滤对婴幼儿体外循环血液流变学的影响

Effects of ultrafiltration on hemorheology in infants during extracorporeal circulation

目的 评估体外循环(ECC)中超滤对婴幼儿血液流变学的影响.方法 选取需在ECC下行心内直视手术的患儿26例,分为无超滤组(W组):在ECC中不行超滤;超滤组(C组):复温至33℃时开始超滤,超滤流量10～15 ml/(kg·min),每组各13例.两组患儿分别于转流前(T1)、升主动脉阻断后10 min(T2)、复温至33℃时(T3)、停机时(T4)、术后24h(T5)和术后36 h(T6)采动脉血检测血液流变学相关指标,同时记录ECC转流时间、阻断升主动脉时间、手术时间;术后随访各组患儿住院天数、ICU停留天数、呼吸机辅助及撤离时间、输血总量、引流量、尿量的情况.结果 ①两组患儿在升主动脉开放后心脏均自主复跳,围术期无死亡病例,均顺利出院.②血液流变学变化:组内效应比较:ECC开始后两组患儿血浆黏度、红细胞刚性指数(IR)、红细胞聚集指数(Agrbc)、红细胞变形指数(TK)、红细胞比容(Hct)、纤维蛋白原(Fib)总体呈下降趋势;超滤后IR、Agrbc比T3时明显升高(P＜0.05);血浆黏度、Fib与T3比较差异无统计学意义(P＞0.05);超滤后各时间点TK无明显差异(P＞0.05);组间效应比较:血浆黏度、IR、Agrbc、TK、Fib两组间比较差异无统计学意义(P＞0.05);Het超滤后各时间点C组比W组明显升高(P＜0.05).③术后随访情况:超滤组ICU停留天数、呼吸机辅助及撤离时间、引流量明显少于无超滤组(P＜0.05).结论 ECC中应用超滤可迅速提高Hct,减少患儿术后的引流量,缩短患儿在ICU的停留时间、呼吸机辅助及撤离时间,有利于心、肺及全身各脏器功能的恢复.同时,超滤对婴幼儿ECC后的红细胞变行性无明显影响,对红细胞的聚集性可能有一定影响.

Objective To evaluate the effects of ultrafiltration on hemorheology in infants during extracorporeal circulation(ECC).Methods 26 patients undergoing open-heart surgery with ECC were randomly divided into two groups:without-ultrafiltration group(W group,n=13) and conventional ultrafiltration(CUF) group(C group,n=13).In W group ultrafiltration didn't be used during ECC,while in C group CUF was started when the temperature rewarming to 33℃,and the flow rate of CUF was controlled to 10~15ml /(kg·min).The arterial blood samples were repeatedly collected at the following time points:before ECC(T1),10 min after the ascending aorta blocked(T2),on rewarming to 33℃(T3),ECC termination(T4),24 h(T5) and 36h after operation(T6).The changes of relative indexes of the blood rheology and ECC time,aortic cross-clamping time,operative time were observed and detected.Meanwhile,the hospital days,ICU residence time,ventilation time,total blood transfusion volume,drainage volume,urine volume of patients followed up in each group were recorded.Results 1.The hearts of all infants in two groups resuscitated automatically after ascending aorta declamping.All patients recovered smoothly and were discharged without perioperative deaths.2.Hemorheology:comparison within groups:after the beginning of ECC,the plasma viscosity,erythrocyte rigidity index(IR),erythrocyte aggregation index(Agrbc),erythrocyte deformation index(TK),hematocrit(Hct) and fibrinogen(Fib) overall had a downward trend in two groups;Compared with those at T3,the IR and Agrbc were significantly higher(P<0.05),while the plasma viscosity and Fib didn't have significant difference(P>0.05) after ultrafiltration;The TK of two groups at the time points after ultrafiltration had no significant difference than those at T1(P>0.05);Comparison between two groups:ultrafiltration had no significant effect on the plasma viscosity,IR,Agrbc,TK and Fib between two groups(P>0.05);The Hct at different time points after ultrafiltration in C group were significantly higher than those in W group(P<0.05).3.Postoperative follow-up results:ICU days,ventilation time and drainage volume in C group were less than those in W group(P<0.05).Conclusion Application of ultrafiltration in infants could rapidly increase the Hct levels during ECC,also could reduce postoperative edema of various organs,decrease the postoperative ICU days of patients,diminish postoperative complications and postoperative bleeding,and improve the recovery of the heart,lungs and other organs.At the same time,It has no significant effect on the red blood cell deformability,while might have some impact on the aggregation of red blood cells.