复合超滤对瓣膜置换术后患者肺功能的影响

The Effect of Compound Ultrafiltration on Postoperative Pulmonary Function of Patients with Cardiac Valve Replacement

目的探讨复合应用改良超滤和零平衡超滤对改善体外循环(extracorporeal circulation,ECC)瓣膜置换术后患者肺功能的效果。方法60例行二尖瓣置换的患者随机分为四组,每组15例:常规超滤组(CUF组)、改良超滤组(MUF组)、零平衡超滤组(ZUF组)和改良超滤+零平衡超滤组(M+Z组)。分别检测和记录各组围术期红细胞比积(Hct),呼吸功能[氧合指数(OI),肺泡-动脉血氧分压差(P(A-a)O2)],呼吸机辅助时间(MAT)及炎性介质[肿瘤坏死因子α(TNF-α)和白细胞介素-6(IL-6)]的浓度。结果术后四组Hct无显著性差异(P>0.05);OIMUF组、ZUF组和M+Z组术后1h、6h、12h、24h高于CUF组(P<0.05);P(A-a)O2M+Z组术后1 h、6 h、12 h、24 h较ZUF组、MUF组和CUF组低(P<0.05);术后呼吸机支持时间M+Z组较ZUF组、MUF组和CUF组短(P<0.05);TNF-α和IL-6浓度M+Z组停机及术后2 h、12 h、24 h和ZUF组较MUF组和CUF组明显降低(P<0.05)。结论零平衡超滤加改良超滤较单一超滤方法能较好地改善瓣膜置换术患者术后肺功能,降低体内炎性介质浓度。

OBJECTIVE To evaluate the effect of using modified ultrafihration and zero - balanced uhrafiltration on postoperative pulmonary function of patients with cardiac valve replacement under extracorporeal circulation.（ ECC ）. METHODS 60 patients underwent mitral valve replacement were randomly divided into four groups：conventional ultrafiltration group（ CUF,n = 15 ）, modified ultrafiltration group（ MUF, n = 15 ）, zerobalanced ultrafiltration group（ ZUF, n = 15 ） and modified ultrafihration ＋ zero - balanced ultrafihration group （ M ＋ Z, n = 15 ）. The hematocrit （ Hct ）, pulmonary function （ OI and P（A-a） O2 ）, mechanical ventilation time （MAT） and the concentrations of tumor necrosis factor - α （TNF - α）and interleukin -6 （IL-6） in the four groups were respectively monitored . RESULTS The Hct was simillar in the four groups（ P 〉0.05） ; At 1 h,6 h,12 h and 24 h after operations, OI in M ＋Z group,ZUF group and MUF group was higher than that in the CUF group （ P 〈0.05） ,P（A-a） in M ＋Z group was lower than that in CUF group,ZUF group and MUF group（ P 〈0.05）. MAT in M ＋Z group was shorter than that in MUF group, ZUF group and CUF group. At 0 h,2 h, 12 h and 24 h after operations, the concentrations of TNF -α and IL -6 in M ＋ Z group and ZUF group was significantly lower than that in the MUF group and CUF group（ P 〈0.05）. CONCLUSION Compared to the uhrafihration with single method, modified ultrafiltration ＋ zero - balanced ultrafiltration can well improve postoperative pulmonary function of patients accepted cardiac valve replacement and decrease inflammatory response.