联合超滤在合并恶液质的心脏瓣膜置换术体外循环中的应用

Application of balanced ultrafiltration in combination with modified ultrafiltration to extracorporeal circutation in valve replacement with cochexia

目的总结联合应用平衡超滤加改良超滤在合并恶液质的心脏瓣膜置换术体外循环(ECC)中的经验。方法本组48例心脏恶液质瓣膜置换术患者在ECC中应用平衡超滤加改良超滤。ECC开始血液动力学稳定后即行超滤。结果ECC时间68～215min,主动脉阻断时间41～186min。超滤时间53～175(57±48)min。滤出液量3500～8900(4200±970)mL。术中维持红细胞容积(HCT)0.20～0.25。改良超滤结束HCT为0.30～0.35。死亡3例,1例死于心功能衰竭无法停ECC,2例术后死于多脏器功能衰竭。结论联合超滤应用于合并恶液质的心脏瓣膜置换术ECC中,不仅迅速滤出体内多余水分,提高HCT和血浆胶体渗透压,还可超滤出中小分子炎性介质和乳酸等不良成分,有利于减少术后并发症,促进各脏器功能恢复。

[Objective] To investigate the application of balanced ultrafiltration in combination with modified ultrafiltration to cxtracorporeal circutation （ECC） in patients who accepted valve replacement with cachexla. [Methotis] The ultrafiltration of balanced and modified method were eombinatively applied to ECC in 48 patients who suffered from valve disturhance with cahexia. The procedure began to perform while hcmodynamics stabilized during ECC. [Results] Time of ECC was from 68 to 215 min, and that of aorta clamps was from 41 to 186 min. Time of ultrafdtration was from 53 to 175 （mean 57±48） min. The fluid uhrafiltrated was from 3 500 to 8 900 （mean 4 200±970）mL. The HCT maintained from 0.2 to 0.25 during ECC, and ascended from 0.30 to 0.35 when the modified ultrafiltration completed. 1 patient died from cardiac function failure, and 2 died from multiple organs failure. [ Condusion] Combined balanced uhrafiltration with modified ultrafiltration to ECC in valve replacement with cachexia, can not only filter the redundant fluid, but also enhance HCT and plasma colloid osmotic pressure, and dear away moderate and small molecular inflammatory medium and lactic acid, and reduce the posoperative complications.