零平衡超滤和改良超滤联合应用对婴幼儿心脏手术后肺功能的影响

Effect of zero-balanced ultrafiltration and modified uitrafiltration on pulmonary function after cardiac surgery in infants

目的:探讨体外循环(cardiopulmonary bypass,CPB)中零平衡超滤(zero-balanced ultrafiltration,ZBUF)和改良超滤(modified ultrafiltration,MUF)联合应用对婴幼儿心脏手术后肺功能的影响。方法:60例接受先天性心脏病手术治疗的患儿,随机分为零平衡超滤组(Z组)、改良超滤组(M组)和零平衡超滤联合改良超滤组(Z+M组)。测定3组患儿CPB前(T1)、CPB后20 min(T2)、术后2 h(T3)、术后6 h(T4)和术后12h(T5)的氧合指数、肺泡-动脉氧分压差、肺静态顺应性和气道阻力。记录3组患儿术后呼吸机辅助时间。结果:3组患儿CPB术后较CPB前的氧合指数和肺静态顺应性明显下降,气道阻力和肺泡-动脉血氧分压差明显升高(P<0.05);在T3,T4和T5时,Z+M组的氧合指数和肺静态顺应性明显高于Z组和M组(P<0.05),肺泡-动脉血氧分压差和气道阻力明显低于Z组和M组(P<0.05);Z+M组术后呼吸机辅助时间比Z组和M组短(P<0.05)。结论:零平衡超滤和改良超滤联合应用能明显改善婴幼儿心脏手术后受损的肺功能。

Objective: To determine the protective effect of zero-balanced ultrafiltration and modified ultrafiltration on infants' pulmonary function after cardiac surgery. Methods: Sixty infants with congenital heart diseases were randomly divided into 3 groups: a zero-balanced ultrafiltration group(Z group), a modified ultrafiltration group(M group) and a zero-balanced ultrafiltration with modified ultrafiltration group(Z+M group). Oxygenation index(OI), difference of alveoli-arterial oxygen pressure(P(A-α)O2), static lung compliance(Cstat), and airway resistance(Raw) were measured before caridopulmonary bypass(CPB, T1), 20 minutes after the CPB(T2), 2 h after the operation(T3), 6 h after the operation(T4) and 12 h after the operation(T5). The time of mechanical ventilation was also monitored. Results: After the CPB, OI and Cstat in all groups decreased significantly, while Raw and P(A-α)O2 increased significantly. At T3, T4 and T5, OI and Cstat in the Z+M group were significantly higher than those in the Z group and the M group(P<0.05), Raw and P(A-α)O2 in the Z+M group were significantly lower than those in the Z group and the M group(P<0.05). The ventilation time in the Z+M group was significantly shorter than that in the Z group and the M group(P<0.05).Conclusion: Zero-balanced ultrafiltration and modified ultrafiltration can effectively promote the pulmonary function after cardiac surgery in infants.