应用负平衡超滤对婴幼儿含血预充液进行生理化调整临床探究.docVIP

应用负平衡超滤对婴幼儿含血预充液进行生理化调整临床探究 　作者：柳薇，缪娜，邢家林，刘瑞芳，吉冰洋 【摘要】 目的 本研究旨在体外循环(CPB)前应用负平衡超滤(UF)技术对预充库存悬红细胞(悬红)的婴幼儿预充液进行超滤和通过恒温36℃的变温水箱对其进行保温，从而使调整后含库存悬红预充液的血气指标、血糖、乳酸、离子水平以及温度更接近婴幼儿的生理水平。方法 随机选取20例10 kg以下婴幼儿在CPB下行心脏手术的循环管路。所有CPB管路均采用一致的配套管道、动脉滤器、超滤器和婴幼儿膜式氧合器。预充均采用150～200 ml悬红、500 ml勃脉力、10 g白蛋白、5%碳酸氢钠20 ml。在预充排气同时通过变温水箱维持预充液温度在36℃，在含血预充液混合10 min后利用已连接好的CPB管路上的超滤器对其进行超滤。并分别抽取库存悬红、混匀后10 min(超滤前)、超滤结束后的含血预充液样本，通过分析比较库存悬红、超滤前、后含血预充液的血气指标和离子水平的变化。结果 与库存悬红相比，超滤前的含血预充液中K+、血糖、乳酸、血气的各项指标均有明显改善(Plt;0.05);与超滤前相比，超滤后含血预充液的离子成分、血糖、乳酸、红细胞比容和胶体渗透压等各项指标均有明显改善(Plt;0.05)。结论 应用超滤的方法处理含库存悬红的预充液并对其进行保温，能有效降低其中的有害成分，使含血预充液的K+、血糖、乳酸以及血气的各项指标趋于生理化，能减少CPB早期因预充库存悬红的不良成分对婴幼儿血流动力学、离子水平等的影响。 【关键词】 体外循环;预充液;悬浮红细胞;超滤;婴幼儿 　　Abstract: OBJECTIVE The purpose of this study is to test the hypothesis that ultrafiltration and warming before cardiopulmonary bypass(CPB) adjust the priming solution with stored blood to reach a physiologic statues of infant’s blood. METHODS We randomly selected identical CPB circuits including tubing, arterial filter, ultrafilter and membrane oxygenator for 20 infants less than 10 kg undergoing cardic surgery. The priming solution included donor red cell, Plasmalyte-A, albumin and sodium bicarbonate. We run the pump and mixed the priming solution about 10 minutes at flow rate 1.5 L/min and maintained the temperature around 36℃ using heat-cooler. Blood samples were obtained from the stored red cell, mixed priming blood and after ultrafiltration for blood gas analyses and ions measurement. RESULTS Compared to stored red cells, the level of lactic acid, blood glucose and K+ were significantly lower in mixed priming soultion(Plt;0.05).The level of Hct, Cop, Lactic acid, blood glucose and K+ were significantly lower after ultrafiltration than before ultrafltration (Plt;0.05).CONCLUSION The negative balanced ultrafiltration and warming of the priming solution can effectively reduce the side effects of stored red cell to children in hemodynamic and ions level . 　　Key words： Cardiopulmonary by