添加甘露醇的预充液对成人体外循环临床结果的影响

The clinical effects of mannitol in the priming fluid of the adult extracorporeal circulation

目的验证甘露醇是否可以改善成人体外循环心脏手术临床结果。方法选取2015年1月1日至2016年3月31日,在本院行冠状动脉旁路移植术和/或心脏瓣膜置换手术患者261例,随机分为甘露醇组(129例)和对照组(132例)。记录两组患者的一般资料,术前和术后血常规和肾功能,机械通气时间和住院时间,术中和术后2 h尿量,术中和ICU红细胞使用量,主要终点事件(院内死亡,脑卒中,心肌梗死,多器官功能衰竭)等,并进行统计学分析。结果两组患者一般资料比较没有显著差别。术前对照组的血肌酐数值大于甘露醇组,但在正常范围。甘露醇组机械通气时间明显长于对照组,术中尿量,超滤数量和术中红细胞使用量也明显高于对照组。两组患者住院时间以及术后血常规和肾功能比较均无统计学差异。甘露醇组有2例发生主要终点事件(1例脑梗死,1例死亡),对照组无主要终点事件,但两组发生率没有统计学差异。结论添加甘露醇作为体外循环预充液成分可以增加患者术中尿量,患者机械通气时间明显延长,甘露醇并不能显著缩短患者住院时间以及降低术后死亡率和并发症的发生率。

Objective The aim of this study was to evaluate the clinical effects of mannitol asacomponent of thepriming fluid of the adult extracorporeal circulation for patients undergoing cardiac surgery. Methods The study included 261 patients who underwent the operations of coronary artery bypass graft and/or valve replacement classified into two groups： mannitol group （n = 129） in which the priming fluid of the circuit contained mannitol, and the placebo group （ n = 132）. The perioperative data and postoperative outcomes were recorded. Results There was no significant differencein the demographic variables between two groups, except the serum creati- nine was higher in control group, which was within the normal range. The control group required shorter time of mechanical ventilation in ICU. The incidence of red blood cell transfusion, ultrafiltration and urine output during cardiopulmonary bypass were higher in man- nitol group. Conclusion The mannitol as the element of the priming fluid of the adult cardiopulmonary bypass did not improve the out- come of the adult patients undergoing cardiac surgery. The mannitol may lead to prolonged mechanical ventilation time.