大容量零平衡超滤下体外循环与非体外循环冠状动脉旁路移植术炎性反应的比较_临床医学论文.docVIP

大容量零平衡超滤下体外循环与非体外循环冠状动脉旁路移植术炎性反应的比较_临床医学论文 大容量零平衡超滤下体外循环与非体外循环冠状动脉旁路移植术炎性反应的比较_临床医学论文 作者：李刚 崔丽芳 郑升法 张念亮 魏伟 王会强 【摘要】 目的 比较大容量零平衡超滤(ZBUF)应用于体外循环(CPB)下冠状动脉旁路移植术(CABG)与非体外循环下CABG(OPCABG)的炎性反应和临床效果。方法 45例接受CABG的患者随机分为常规CPB组(A组)，常规CPB+零平衡超滤组(B组)和非体外循环组(C组)，每组各15例。ZBUF采用的滤器为滤过面积0.5m2，孔径允许65-kDa物质通过，B组体外循环全程采用勃脉力(Plasmalyte)等量置换滤出液。观察麻醉诱导前、术中、术后即刻、术后4 h、24 h血浆中白细胞介素(IL)-6、 IL-8、 肿瘤坏死因子-ɑ(TNF-ɑ)浓度，术后肺泡-动脉氧阶差、呼吸机支持时间及ICU停留时间。结果 与麻醉诱导前相比，三组炎性介质术后均显著升高，持续到术后24 h，A组最明显，与另外两组比较有统计学意义。B组平均超滤4015 ml，术后早期炎性介质浓度明显低于另两组。B、C两组术后呼吸机支持时间和ICU停留时间显著少于A组。结论 大容量零平衡超滤可有效滤出炎性介质，减轻CPB所致炎性反应，与非体外CABG相比，同样可缩短机械通气和ICU停留时间。 【关键词】 零平衡超滤;炎性介质;体外循环;非体外循环下冠状动脉旁路移植术 　　Abstract: OBJECTIVE This study was performed to compare clinical effects and inflammatory mediator removal by high-volume, zero-fluid balance ultrafiltration(ZBUF) between on pump CABG and OPCABG. METHODS Forty-five adult patients undergoing CABG open-heart procedure were randomized to three group. A: conventional CABG(on-pump, no ultrafiltration) ,B group:on-pump CABG with the zero-balance ultrafiltration (ZBUF) and C group:OPCABG. ZBUF was performed by using a 65-kDa ultrafilter with 0.5 m2 surface area，A volume of a balanced salt crystalloid solution (Plasmalyte) equal to the filtered blood volume was given to replace the fluid removed. Plasma interleukin IL-6, IL-8, and tumor necrosis factor(α-TNF) were measured at before induction (T1),10 min after onset of bypass (T2), terminal of bypass (T3), 4 h(T4) and 24 h (T5) postoperative. Postoperative alveolar-arterial oxygen gradient, time to intubation and ICU-stay were monitored. RESULTS The plasma concentration of inflammatory mediator were increased notably in three group after operation. Average volume of filtrate removed was 4105 ml in group B during ZBUF. In B group( ZBUF), the patients had a significant lower in IL-6,8 and TNF compared with group A and C in the early postoperative. The mechanical ventilation supporting time and ICU-stay in group B and C were significantly shorter t