含血预充液超滤洗涤对婴幼儿CPB期间内稳态的影响

Effects of priming solution with blood ultrafiltration washing on homeostasis during cardiopulmonary bypass in infants

目的探讨含血预充液超滤洗涤对婴幼儿心肺转流(CPB)期间内稳态的影响。方法施行先天性心脏病手术治疗患儿30例,随机均分为两组:A组术前利用CPB管道中血液超滤器对含血预充液进行超滤洗涤20min;B组预充液在CPB管道中循环20min。测定A组含血预充液超滤洗涤前、后及两组麻醉诱导后CPB前(T0)、升主动脉阻断10min(T1)、升主动脉开放10min(T2)和CPB结束时(T3)血气分析和电解质等指标。结果与B组比较,A组超滤后血液pH、PaO2、碱剩余值较超滤前升高(P<0.05),PaCO2、K+、乳酸(Lac)、BG、TNF-α浓度均降低(P<0.05)。A组Glu在T1、T2、T3时均低于B组(P<0.05);Lac在T2时低于B组(P<0.05)。结论含血预充液进行超滤洗涤预处理可降低库血的有害成份,减轻CPB期间血Lac和Glu水平升高,改善CPB期间机体内环境。

Objective To investigate the effects of priming solution with blood ultrafiltration washing on the homeostasis during eardiopulmonary bypass （CPB） in infants. Methods A total of 30 infants with congenital heart disease was randomly divided into two groups of A （using blood uhrafitter of CPB pipeline to wash priming solution with blood for 20 minutes） and B（circulated in CPB pipeline for 20 minutes）. Blood gas analysis, electrolytes and other indexes were analyzed in group A before and after uhrafiltration washing, and at the times of before CPB（T0）, ascending aorta occlusion 10 minutes（T1）,ascending aorta opening 10 minutes（T2） and the end of CPB （T3） in both groups. Results Compared with group B, blood pH value, PaO2 and base excess of group A after ultrafihration were higher, and PaCO2, K＋ , lactic acid（Lac）, BG, and TNF-a concentration were lower than those before（P^0.05）. BG at T1, T2 and T3 was lower, and Lac at T2 was lower, in group A than those in group B（P%0. 05）. Conclusion The harmful components in bank blood, high Lac and Glu can he decreased by uhrafiltration washing of priming solution with blood, which is helpful in keeping homeostasis in infants undergoing CPB.