联合超滤减轻体外循环对低体质量婴儿心脏手术后的肺损伤

Combined ultrafiltration can attenuate lung injury duing cardiopulmonary bypass after cardioac operation in low weight infants

目的对比研究体外循环(CPB)中联合超滤方法和常规超滤方法对低龄低体质量婴幼儿心脏手术后肺功能的影响。方法将40例6 kg以下行心脏手术的婴幼儿患者分为联合组(n=20)和常规组(n=20),联合组采用零平衡超滤、常规超滤和改良超滤,常规组仅做常规超滤。观测两组患儿的超滤液量、血液浓缩指标、术后呼吸功能{氧合指数、肺泡-动脉氧分压差[(A-a)DO2]}、肺的静态顺应性、呼吸机通气时间和ICU停留时间。结果联合组患者用血量明显少于常规组,联合组患者血浆蛋白和红细胞比容(HCT)明显高于常规组。联合组患者术后肺的通气和换气功能均获改善。联合组患者术后白细胞和中性粒细胞均低于常规组。结论联合超滤方法在血液浓缩、降低白细胞和中性粒细胞等炎性介质方面明显优于常规超滤,能明显改善低龄低体质量婴幼儿的肺功能。

Objective To compare the effects of combined ultrafiltration and conventional ultrafiltration in protecting patients′ pulmonary function duing cardiopulmonary bypass of infants.Methods Forty infantile cardiac surgery patients（weight less than 6 kg）were divided into two groups：combined ultrafiltration group（n=20）and conventional ultrafiltration group（n=20）.Combined ultrafiltration group did zero balanced ultrafiltration,conventional ultrafiltration and modified ultrafiltration in turn.Conventional group only did conventional ultrafiltration.The volume of ultrafiltration,hematocrit（HCT）,concentration of serum album before/ after ultrafiltration were observed.The pulmonary function parameters after the operation,such as oxygenation index,alveolar-arterial oxygen difference（A-aDO2）,static lung compliance,ventilator time and ICU stay time,were respectively monitored.Results Comparing with the conventional group,the blood volume needed in the operation was significantly less,HCT and concentration of serum album in after operration were significantly much increased in the combined ultrafiltration group.The improvement of lung ventilation and gas exchange in the combined ultrafiltration group were significantly obvious than that in the conventional group.In the combined ultrafiltration group,the count of white blood cell,neutrophilic granulocyte after operation and other inflammatory mediators were significantly lower than those in conventional ultrafiltration.For the combined ultrafiltration group,the improvement of lung function was more obvious,especially to the low age and weight infants.Conclusion Combined ultrafiltration has more effictive in protecting patients′ pulmonary function duing cardiopulmonary bypass of infants compared with conventional ultrafiltration,especially to the low age and weight infant.