血液滤过膜对心肺转流术后呼吸功能的影响

Effects of hemofiltration with different membranes on respiratory function after cardiopulmonary bypass

目的 研究在心肺转流术中使用两种不同的膜材料进行血液滤过对术后呼吸功能的保护效果。方法 选择2 0 0 2 - 10～ 2 0 0 3- 0 9接受心内直视手术患者 2 0例 ,随机分成吸附组 (n =10 )和对照组 (n =10 ) ,前者使用AN6 9膜 ,后者使用PS膜进行术中血液滤过。各组均分别于心肺转流前、心肺转流结束时及心肺转流结束后 6 0、12 0、180、2 4 0min测定气道平台压(PPlateau)、气道峰压 (PPeak)、静态胸肺顺应性 (Cst)、动态胸肺顺应性 (Cdyn)和呼吸指数 (RI)的变化。结果 在心肺转流结束至心肺转流结束后 2 4 0min期间 ,吸附组PPlateau、PPeak和RI升高及Cst和Cdyn降低的程度低于对照组 (P <0 0 5 ) ,持续时间短于对照组 (P <0 0 5 )。两组均无死亡 ,无血红蛋白尿。结论 用AN6 9膜较PS膜血液滤过更明显地减轻心肺转流引起的肺损伤 。

Objective To investigate the protective effect of hemofiltration with two different membranes on pulmonary function after cardiopulmonary bypass (CPB). Methods Thirty patients underwent cardiac surgery with CPB and were divided at random into absorption group (n=10) and control group (n=10). Absorption group hemofiltrated with AN69 membrane and control group with PS membrane during CPB. Plateau airway pressure(P Plateau ), peak airway pressure(P Peak ), static pulmonary compliance (Cst), dynamic pulmonary compliance (Cdyn) and respiratory index (RI) were measured or calculated before CPB, end of CPB and 60, 120, 240 min after CPB. Results Compared with control group, from end of CPB to 240 min after CPB, the degree and persisting time of P Plateau , P Peak , RI increasing and Cst, Cdyn reducing in absorption group were lower and shorter ( P <0.05). No operative death and no hemogolobinuria was found during and after CPB in all the patients. Conclusion Hemofiltration with AN69 membrane than with PS membrane more evidently reduce lung injury due to CPB and improve respiratory function.[