改良超滤对瓣膜置换围术期心肺功能的影响

Effect of Modified Ultrafiltration after Heart Valve Replacement

目的通过对心脏瓣膜置换术患者在体外循环(Extracorporeal c ircu lation,ECC)各时段炎性因子和血流动力学变化的观察,探讨超滤技术对其的影响。方法选取拟行双瓣膜置换术(DVR)的30例患者,随机分成两组,Ⅰ组为超滤组(MUF),Ⅱ组为对照组。分别在ECC前(T1)、主动脉阻断后30 m in(T2)、ECC结束时即刻或MUF开始即刻(T3)、ECC结束后15 m in或MUF结束即刻(T4)、ECC结束后30 m in(T5)、ECC结束后2 h(T6)、ECC结束后8 h(T7)、ECC结束后24 h(T8)取血测定血清白细胞介素(IL)-6、IL-8、内皮素(ET)-1的浓度,并在相应时间点监测两组患者的肺功能及血流动力学变化。结果两组患者血浆中IL-6、IL-8、ET-1的含量在ECC开始后迅速升高,MUF组与对照组之间IL-6、IL-8、ET-1的血浆含量在ECC后各时间点的比较差异非常显著(P<0.05);MUF组超滤前后CO、C I、MAP、LVSW I差别有显著意义(P<0.05),对照组停ECC时与ECC结束后15 m in相比各指标差异无显著意义。MUF组超滤后与对照组停ECC 15 m in时相比C I、LVSW I的差异有显著意义(P<0.05);MUF组ECC后各时间点肺功能损伤程度明显低于对照组(P<0.05)。结论MUF可迅速滤出体内多余水分,浓缩血液,并可滤出炎性介质等有害物质,减轻手术及ECC引起的炎性反应,改善患者的心肺功能,减少了术后多器官功能衰竭(MOF)发生。

OBJECTIVE To evaluate the effect of modified ultrafiltration（MUF） on inflammatory response and alteration of hemodynamics during extracorporeal circulation （ECC）. METHODS 30 patients who underwent double valves replacement（DVR） were randomly divided into modified ultra_filtration group（group Ⅰ ,n = 14）and control group（ group Ⅱ ,n = 16）without MUF. Blood samples were taken before surgery,30 minutes after aortic occlusion, immediately after ECC or beginning of MUF,at 15 minutes after ECC or the end of MUF,30 minutes,2 hours,8 hours,24 hours after ECC to measured the concentrations of Interleukin - 6 （ IL - 6）, Interleukin - 8 （ IL - 8 ）, Emlothelin - 1 （ ET - 1 ）. Lung function and alteration of hemodynamics are measured during perioperation. RESULTS All patients＇concentrations of IL - 6, IL - 8 and ET - 1 increased after beginning of ECC. The difference between 2 groups at all time points after ECC were significant（ P 〈0.05）. In the MUF group,the changes of CO,CI,MAP,LVSWI is significant（ P 〈0.05）, the difference of CI,LVSWI between 2 groups were significant at 15 minutes after ECC（ P 〈0.05）, and the lung function is far better than that in control group at every time point after ECC （ P 〈 0.05 ）. CONCLUSION MUF can filter out the supernumerary water and eoncentrat the blood. Also the inflammatory mediators can be removed by ultrafiltration. Alleviate the inflammatory response after operations with ECC, condition the cardiopulmonary function of patients and decrease occurrence of multiple organ failure（MOF） after operations.