改良的改良超滤在婴幼儿体外循环中应用

The Clinical Application of Modified Ultrafiltration during Extracorporeal Circulation in Infants

目的总结婴幼儿先天性心脏病（CHD）患儿体外循环（extracorporeaL circulation,ECC）中进行改良超滤技术（静脉-动脉通路）的临床经验。方法我院自2004年11月至2007年6月在240例婴幼儿ECC结束后应用改良超滤（静脉-动脉通路）。观察全组患者改良超滤的时间、滤出液量、术中红细胞压积（Hct）、改良超滤结束时Hct、术后呼吸机辅助时间、术后24 h胸腔引流量、术后输入库血量。结果240例患儿未发现同ECC有关的并发症,ECC时间为49-184 min、升主动脉阻断时间17-110 min,改良超滤滤出液体150-400 ml,全组患者术中Hct维持0.16-0.20,改良超滤结束Hct为0.30-0.39,术后呼吸机辅助时间6-72 h,24 h胸腔引流量30-110ml,术后输入库血量100-200 ml。结论改良超滤（静脉-动脉通路）具有迅速滤出体内多余水份,促进各脏器功能恢复的作用,并可有效减少术后并发症,减少输血量,有利于婴幼儿的术后恢复。

OBJECTIVE To sum up the clinical experience of modified venous-arterial ultrafiltration（MUF） when it was applied to the extracorporeal circulation（ECC） in infants who underwent repair of congenital heart disease（CHD）.METHODS From November 2004 to June 2007,the MUF was applied to 240 infants after ECC in our hospital.The clinical data,including time of MUF,ultrafiltration volume,intraoperative hematocrit（Hct）,hematocrit after MUF,mechanical ventilation support time after operation,volume of thoracic drainage within 24 hours after operation,volume of postoperative blood transfusion,were observed in all of the 240 infants.RESULTS There were no complications relating to ECC in all of the 240 infants.The ECC time ranged from 49 min to 184 min and the aorta cross-clamp time ranged from 17 min to 110 min.The ultrafiltration volume ranged from 150 ml to 400 ml.The intraoperative Hct ranged from 16% to 20% and the hematocrit after MUF ranged from 30% to 39%.The mechanical ventilation support time after operation ranged from 6 h to 72 h.The volume of thoracic drainage within 24 hours after operation ranged from 30 ml to 110 ml and the volume of postoperative blood transfusion ranged from 100 ml to 200 ml.CONCLUSION MUF can filter surplus water quickly and promote various internal organs,function recovery.Meanwhile,it can reduce postoperative complications effectively and cut down postoperative blood transfusion.So that it is helpful to the convalescence of infants.