新型超滤技术在婴幼儿体外循环手术中的临床应用

The Clinical Application of New Type Ultrafiltration Technique during Cardiopulmonary Bypass in Infants

目的探讨新型超滤技术的临床应用和防止和减轻体外循环(CPB)后重要器官损伤的作用,以提高手术治疗效果,减少术后并发症。方法将30例先天性心脏病患者分成两组,改良超滤组(n=15):常规CPB后应用改良超滤;新型超滤组(n=15):CPB手术中应用新型超滤方法;观察两组患者血浆中炎症介质浓度、红细胞压积(HCT)、白蛋白浓度、肺功能指标、手术时间和器官功能指标的改变。结果新型超滤组CPB后超滤时间较改良超滤组明显缩短(6.35±1.28 min vs.12.45±4.52 min,P=0.000);CPB结束后血浆白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)浓度明显低于改良超滤组(292.84±58.23μg/L vs.383.79±66.24μg/L,P=0.000;13.32±2.31μg/L vs.16.41±2.65μg/L,P=0.000);CPB结束后HCT和白蛋白浓度明显高于改良超滤组(0.39±0.04 vs.0.35±0.03,P=0.003;38.32±4.26 g/L vs.34.04±2.83 g/L,P=0.003);术后呼吸机辅助时间和住ICU时间均短于改良超滤组(P<0.05),重要器官功能损害较改良超滤组轻。结论CPB中采用新型超滤技术,可有效地减少部分炎症介质,浓缩血液,缩短手术时间,减轻重要器官组织的水肿和损伤。

Objective To investigate the effect of new type ultrafiltration technique in preventing and relieving the main organ injury that may follow open heart surgery with cardiopulmonary bypass （CPB）, and improve the operative effects and decrease the postoperative complications. Methods Thirty patients with congenital heart diseases were randomly divided into two groups. Modified ultrafiltration group： modified ultrafihration was used after CPB; new type ultrafiltration group： new type uhrafihration technique was used throughout CPB. The serum concentrations of inflammatory mediators,hematocrit, serum albumin concentrations, pulmonary function, operative duration time and main organ function parameters were measured in both groups. Results Ultrafihration time after CPB in new type uhrafiltration group was significantly shorted as compared with modified uhrafihration group（6. 35 ±1. 28 min vs. 12.45 ± 4.52 min, P = 0. 000） ; serum concentrations of interleukin-6 （ IL-6 ） and tumor necrosis factor α （TNF-α） after CPB were significantly decreased as compared with modified uhrafiltration group（292.84± 58.23 μg/L vs. 383. 79 ± 66.24 μg/L, P=0. 000; 13.32±2.31 μg/L vs. 16.41±2.65 μg/L, P=0.000） ; the hematocrit and serum albumin concentrations at the ten minutes after CPB were increased as compared with modified uhrafihration group （0. 39± 0.04 vs. 0.35±0.03, P=0.003; 38.32±4.26 g/L vs. 34.04±2.83 g/L, P=0.003）; the mechanical ventilation support time and ICU time after operation was shorted as compared with modified ultrafihration group （P〈0. 05） main organ function was improved as compared with the modified uhrafiltration group application of new type uhrafiltration throughout CPB can effectively exclude some harmful concentrate blood, short operation time, attenuate the main organ edema and injury. Conclusion The clinical inflammatory mediators, concentrate blood, short operation time, attenuate the main organ edema and injury.