体外循环中应用血液透析的初步体会

Hemodialysis Used In Cardiopulmonary Bypass

目的 对 2 0 0 3年 3月～ 2 0 0 2年 9月间的 5例术前严重肾功能受损的心脏手术患者在体外循环 (CPB)中应用血液透析以减少手术风险。方法 常规进行CPB ,预充液中加入甲基强的松龙 5 0 0mg ,蛋白 2 5 g～ 40 g。采用低温、2 .4～ 2 .8L/ (min·m2 )高流量灌注 ,平均动脉压在 70mmHg以上 ,Hct保持在 2 2 %～ 2 5 %。CPB中应用血液透析 ,透析机为Gam -broAK90 (Sweden) ,透析器为SAXON(Germany) ,透析血流量为 15 0～ 2 5 0ml/min。结果 术中BUN下降到 ( 2 3 .8± 7.7)mmol/L与术前相比有及其显著差异 ( p<0 .0 1) ,术后f非蛋白氮 (BUN)为 ( 3 0 .5± 11.7)mmol/L ,与术前比仍有显著下降 ( p<0 .0 5 )。患者出院时肌酐 (Cr)为 ( 1.3 5± 0 .5 5 )mmol/L ,与术前比有显著下降 ( p <0 .0 5 )。 4例患者转流中尿少( 5 0～ 10 0ml)。 5例患者术中透析液量为 45 0～ 13 0 0 ( 975± 3 2 2 )ml。 2例患者在CPB后立即进行了肾异位移植术 ,1例在ICU透析 3d。 5例患者于术后 14～ 5 6d均康复出院。结论 CPB中恰当地使用血液透析对于具有CPB手术指征又伴有严重的肾功能不全的患者可降低BUN、排除分水 。

OBJECTIVE Introduced the experience of using hemodialysis during CPB for 5 patients with severe renal failure or low function underwent heart surgery from March 2000 to September 2002. METHODS Convention of CPB was used. 500 mg methylprednisolone and 25g～40g albumin were added into priming solusion. Moderate hypothermia, high flow rate 2.4～2.8L/(min.m 2), MAP at about 70 mmHg, Hct at 22%～25% were used. A shunt flow of 150～250 ml/min from artery filter through hemodialyser (Gambro AK90; SAXION Germany) was set and used during CPB. RESULTS BUN conpared preoperation decreased to (23.8±7.7) mmol/L(p<0.01) at the end of CPB. Postoperative BUN was (30.5±11.7) mmol/L(p<0.05), Cr (1.35±0.55) mmol/L (p<0.05). Urine output during CPB was only 50～100ml in 4 patients. 450～1 300 ml (978±322)ml water was removed from dialyser during after heart surgery and one recived hemodialysis for 3 days in ICU. All patients were discharged from hospital 14～56 days postoperatively.CONCLUSION Intraoperative hemodialysis can decrease BUN and remove water during CPB for patient who with severe low renal function lt is benefit for these patients to have a better condition in postoperative period.