复合超滤对瓣膜置换术后心功能的影响

The Effect of Compound Ultrafiltration on Postoperative Cardiac Function in Cardiac Valve Replacement

目的探讨应用复合超滤对改善凤湿性心脏病患者体外循环(extracoporeal circulation,ECC)瓣膜置换术后心功能的临床效果。方法 60例行二尖瓣置换的患者随机分为四组:常规超滤组(CUF组,n=15)、改良超滤组(MUF组,n=15)、零平衡超滤组(ZUF组,n=15)和复合超滤组(M+Z组,n=15)。分别检测各组围术期呼吸机辅助时间(MAT)、心脏指数(CI)及炎性介质肿瘤坏死因子α(TNF-α)和白细胞介素-8(IL-8)的浓度。结果术后M+Z组呼吸机支持时间较MUF组、ZUF组和CUF组短(P<0.05);M+Z组术后2h、12h、24h、48h心脏指数(CI)较ZUF组、MUF组和CUF组高(P<0.05);M+Z组和ZUF组停机及术后2h、12h、24h TNF-α和IL-8浓度较MUF组和CUF组明显降低(P<0.05)。结论复合超滤较单一超滤方法能较好地降低炎性反应,改善瓣膜置换术患者术后心功能。

Objective To study the clinical evaluation of using compound ultrafiltration on effect of cardiac function in cardiac valve replacement under ECC. Methods 60 patients who underwent mitral valve replacement under ECC were randomly divided into four group：conventional ultrafiltration group （ CUF, n=15 ） , modified ultrafiltration group （ MUF, n=15 ）、zero-balanced ultrafiltration（ZUF,n=15）and Compound Ultrafiltration（M ＋Z,n =15）. The patient’s time of mechanical ventilation （MAT）、Cardiac index（CI） and the concentrations of tumor necrosis factor-α（TNF-α）and interleukin-8（IL-8）in the four groups were respectively monitored . Results After operation,the time of mechanical ventilation in M＋Z group was shorter than that in MUF group、ZUF group and CUF group;At 2h、12h.、24h and48h after operations the CI in M＋Z group was higher than that in the ZUF group、MUF group and CUF group（P〈0. 05）;At 0h、2h、12h and 24h after opertitions,The concentrations of TNF-α and IL-8 in M＋Z group and ZUF group was lower significantly than that in the MUF group and CUF group（P〈0. 05）. Conclusion Compared to the ultrafiltration with single method, Compound ultrafiltration can decrease inflammatory response, improve batter postoperative cardiac function of patients in cardiac valve replacement under ECC.