零平衡超滤对心脏瓣膜置换术后患者肺功能的影响.DOCVIP

临床医学论文-零平衡超滤对心脏瓣膜置换术后患者肺功能的影响 ????????????????????? 作者：郑民,张卫, 郭震, 李欣，叶伟??? 【摘要】? 目的 评估体外循环（Extracorporeal circulation，ECC）中采用零平衡超滤对成人心脏瓣膜病术后肺功能的影响。方法 2004年5月至2005年2月，二尖瓣置换术或二尖瓣与主动脉瓣联合置换术的患者40例，每组20例；对照组不做任何形式的超滤；试验组ECC中行零平衡超滤，超滤量约60 ml/kg，平均3 417 ml／人。分别在诱导后、ECC结束后2 h、24 h 和48 h 测定肿瘤坏死因子α（TNF－α）的浓度。在术前、诱导后、ECC结束后2 h、12 h、24 h 和48 h 监测肺泡－动脉血氧分压差P（A-a）O2；监测术前、诱导后、ECC结束后2 h、12 h、24 h、48 h 的肺动脉压力；记录术后呼吸支持时间。结果 两组均无死亡，对照组二次ECC 1 例；试验组的术后呼吸支持时间明显少于对照组（P＜0.05）；两组间TNF-α浓度在诱导后、ECC结束后48 h 没有显著性差异，而在ECC结束后2 h，试验组要低于对照组（P＜0.05）；ECC结束后24 h，试验组也明显低于对照组（P＜0.01）；肺泡动脉血氧分压差在ECC结束后2 h，试验组要低于对照组（P＜0.05）；两组的肺动脉压力均无显著性差异；结论 ECC中采用零平衡超滤对心脏瓣膜病患者ECC术后的肺功能有一定程度的保护作用。 【关键词】? 心脏瓣膜；肺功能；超滤 　　Effect of Zero-Balanced Ultrafiltration on Postoperative 　　Abstract: OBJECTIVE?? The aim of this study is to assess the effect of zero-balanced ultrafiltration on postoperative lung function of adult valve cases.METHODS?From May 2004 to Feb 2005, 40 mitral valve disease or double valve cases underwent valve replacement in shanghai chest hospital randomly enrolled in this study, randomly separated into two groups, 20 cases each.. Control group did not use any means of ultrafiltration. Trial group underwent zero-balanced ultrafiltration. Ultrafiltrated fluid is 60ml/kg and mean 3417ml each case. Analysis TNF－α? concentration at follow point: after induction of anesthesia, post-ECC 2 hours, 24 hours, 48hours；calculate P（A-a）O2 at preoperation normoxia state, after induction of anesthesia, post-ECC 2 hours, 12 hours, 24 hours, 48 hours.Pulmonary artery pressure also detected at same point.RESULTS? There were no death in two groups.In control group,there was one patient reperfusion. Trial group respiration support time is shorter than that of control group(P＜0.05). In post-ECC 2hours, trial group TNF－α is lower(P＜0.05).In post-ECC 24 hours, trial group TNF－α? is also lower(P＜0.01). In post-ECC 2 hours, trial group P（A-a）O2 is lower(P＜0.05), they make significant differences.Two groups pulmonary artery pressure