变温式改良超滤改善婴幼儿心脏手术的预后_临床医学论文.docVIP

变温式改良超滤改善婴幼儿心脏手术的预后_临床医学论文 变温式改良超滤改善婴幼儿心脏手术的预后_临床医学论文 作者：李刚，芶大明，杜磊，安琪，赁可，邓硕曾，刘进 【摘要】 目的 探讨变温式改良超滤对婴幼儿心脏手术预后的影响。方法 选择同一外科组先天性心脏病患儿20例，配对法平均分为两组。两组均在体外循环(extracorporeal circulation,ECC)停止后开始超滤。改良超滤组血液未经变温直接进入右房；变温式改良超滤组血液变温后汇入右房。观察两组患儿超滤前后的体温和红细胞比积(Hct)、超滤量、超滤时间、术后出血量、红细胞悬液和血浆用量、正性肌力药使用时间和ICU停留时间。结果 20例患儿无一例死亡。超滤后体温在改良超滤组显著下降(0.01)，而变温式改良超滤组与超滤前无差异，显著高于改良超滤组(0.01)。变温式改良超滤组的超滤时间、术后出血量、血浆及红细胞悬液用量和正性肌力药使用时间，均显著低于改良超滤组(0.05)。结论 变温式改良超滤能保持体温恒定，缩短超滤时间，减少术后出血和输血量，促进心功能的恢复，从而改善患儿预后。 【关键词】 变温；改良超滤；婴幼儿；体外循环 Abstract: OBJECTIVE To observe the effect of warm-keeping modified ultrafiltration (WMU) to pediatric outcomes after extracorporeal circulation(ECC),compared with traditional modified ultrafiltration (TMU). METHODS 20 patients with in congenital heart disease (CHD) a same surgery group were randomly divided into:WMU gruoup and TMU group (n=10 in each group) according to whether performing blood warmed during modified ultrafiltration after ECC. The body temperature,urine and duration of ultrafiltration,inotropic supports,chest drainage,transfusion and retention in ICU were surveyed to access the influence of WMU on pediatric outcomes. RESULTS No death occurred during observation. In TMU group, the body temperature significantly decreased after filtration (0.01). However, the body temperature was normal after filtration in WMU group,and it was significantly higher than that in TMU group (0.01). The filtration time,chest drainage,transfusion of packed red blood cells and fresh frozen plasma,and duration of inotropic support were significantly lower in WMU group than in TMU group (0.05). The ICU stay time was also lower in WMU group,but with no statistical difference (Pgt;0.05). CONCLUSION Compared with TMU, warm-keeping modified ultrafiltration can keep the normal body temperature, and improve pediatric outcomes after ECC. Key words： Warm-keeping; Modified ultrafiltration;Extracorporeal circulation;Pediatric 体外循环（extracorporeal circulation，ECC）后使用改良超滤能够改善手术患儿的预后［1-3］，但常引起体温