高流量改良超滤法的临床应用

Clinical Evaluation of High Flow Rate Modified Ultrafiltration

目的 评估高流量改良超滤法的临床效果及其对机体循环状态的影响。方法 先天性心脏病患儿32例,体重均<10kg,在体外循环结束后进行高流量改良超滤(10～50ml·kg^(-1)·min^(-1)),记录血液浓缩指标和循环指标。结果 超滤开始流量13ml·kg^(-1)·min(-1)左右,最高达(41.05±5.92)ml·kg^(-1)·min^(-1),大部分患儿超滤最高流量达到了50ml·kg^(-1)·min^(-1),超滤时间为(8.13±1.68)min,滤出液量为(353.70±58.72)ml。在整个超滤过程中,血细胞比容提高了40％;循环指标显示在左房压无明显变化的情况下,血压显著上升,心率有所下降。结论 采用高流量进行改良超滤可以缩短超滤时间约1/3,且同样可达到满意的血液浓缩效果,不影响患儿的循环稳定性,并能促进心功能的恢复。

Objective To evaluate the effect of high flow rate modified ultrafiltion( MUF) on hemodynamic change. Methods The high flow rate (10-50 ml·kg-1·min-1 ) MUF was used after car-diopulmonary bypass in 32 children less than 10kg with congenital heart disease. The hematocrit and hemodynamic changes were recorded. Results The beginning flow rate of MUF is about 13 ml·kg-1·min-1 and the highest flow rate during MUF is (41. 05±5. 92) ml·kg-1·min-1. In most cases, the highest flow rate is up to 50 ml·kg-1·min-1. The duration of MUF is (8. 13±1. 68) min (6.5-11 min) and the volume filtered was (353.70±58. 72) ml. Hematocrits increased about 40% and blood pressures elevated, heart rates decreased without changes of left atrium pressures. Conclusion Using high flow rate, the duration of MUF can be shortened about one third. Alike MUF, the blood can also be concentrated to the similar degree. The hemodynamic stability are not affected by the high flow rate and the cardiac function can also be improved.