超滤在重症心脏瓣膜置换术体外循环中的临床应用

Clinical Application of Ultrafiltration in Severe Heart Valve Replacement With Cardiopulmonary Bypass

目的 探讨超滤在重症心脏瓣膜置换术体外循环（Extracorporeal circulation，ECC）中的临床应用价值。方法 2004年1月～12月中南大学湘雅二医院共行心脏瓣膜置换术500例，对其中123例重症心脏瓣膜置换术患者在ECC中应用超滤脱水技术。超滤是在ECC开始平稳后或机体复温后进行。结果 全组病例超滤时间为35～195（46±52）min，滤出液量800～10000（2300±824）ml。所有病例停ECC时红细胞压积得到提高，关胸时术野渗血减少，患者术后肺部并发症减少，恢复平稳。结论 ECC中应用超滤方法可迅速排除体内过多的水分和中小分子炎性介质等有害成分，能迅速浓缩血液，减轻患者术后各脏器水肿，减少术后各脏器并发症，有利于心、肺功能恢复，提高手术的安全性。

OBJECTIVE To study the clinical application of uhrafiltration in severe heart valve replacement with extracorporeal circulation（ECC） . METHODS From January to December of 2004,123 cases of severe heart valve replacement were used ultrafiltration in ECC. The time course of ultrafiltration was in the rewarming period or before. RESULTS The time for ultrafiltration was 35 to 195 minutes （mean 46 ± 52 minutes） and the ultrafiltration volumes were 800 to 10000 ml（mean 2300 ± 824 ml）. It has significant effect on hemoconcentration. CONCLUSION Ultrafiltration can quickly filter out the supernumerary water, decrease the inflammatory mediators, concentrate the blood and improve the function of organs after operations. It＇s useful to improve the security of operations.