复合超滤对小儿先天性心脏病术后肺功能影响.docVIP

复合超滤对小儿先天性心脏病术后肺功能影响 　 作者：杨小云，刘宝玉，周凯，姜建青，丁盛，高峰，吴凡，宋恒昌 【摘要】 　　目的 探讨复合应用改良超滤和零平衡超滤对改善小儿先天性心脏病体外循环（extracorporeal circulation,ECC）术后肺功能的临床效果。方法 60例行室间隔缺损修补术（VSD）的患儿随机分为四组：常规超滤组（CUF组，n =15）、改良超滤组（MUF组，n =15）、零平衡超滤组（ZUF组，n=15）和改良超滤+零平衡超滤组（M+Z组，n=15）。分别检测各组围术期红细胞压积（Hct），呼吸功能氧合指数（OI），肺泡-动脉血氧分压差（P（A-a）O2），呼吸机辅助时间（MAT）及炎性介质肿瘤坏死因子α（TNF-α）和白细胞介素-6（IL-6）的浓度。结果 术后各组Hct无显著性差异（Pgt;0.05）； M+Z组、ZUF组和MUF组术后1 h,6 h,12 h,24 h OI高于CUF组（Plt;0.05），而M+Z组术后1 h,6 h,12 h,24 h P（A-a）O2较ZUF组、MUF组和CUF组低（Plt;0.05）； M+Z组术后呼吸机支持时间较MUF组、ZUF组和CUF组短（Plt;0.05）；M+Z组和ZUF组停机及术后2 h,12 h,24 h TNF-α和IL-6浓度较MUF组和CUF组明显降低（Plt;0.05）。结论 零平衡超滤加改良超滤较单一超滤方法能较好地改善小儿先天性心脏病患者术后肺功能，降低体内炎性介质浓度。 【关键词】 超滤　体外循环　肺功能　先天性心脏病 　　The Effect of Compound Ultrafiltration on Postoperative Lung Abstract: OBJECTIVE To study the clinical evaluation of using modified ultrafiltration and zero-balanced ultrafiltration on effect of postoperative lung function of infants with congenital heart disease under ECC. METHODS 60 patients who underwent ventricular septal defect（VSD）repaired were randomly divided into four group：conventional ultrafiltration group(CUF,n=15),modified ultrafiltration group(MUF, n=15),zero-balanced ultrafiltration（ZUF,n=15） and modified ultrafiltration+zero-balanced ultrafiltration(M+Z,n=15).The hematocrit(Hct),the patient’s respiration function(OI and P（A-a）O2), the time of mechanical ventilation and the concentrations of tumor necrosis factor(TNF-α) and interleukin-6(IL-6) in the four groups were respectively monitored . RESULTS The Hct in the four groups was similar （Pgt;0.05）. At 1 h，6 h，12 h and 24 h after operations the OI in M+Z group ，ZUF group and MUF group was higher than that in the CUF group （Plt;0.05）；Comparing to in the other three groups, the P（A-a）O2 at 1 h,6 h,12 h and 24h after operations in M+Z group was lower （Plt;0.05）,and the time of mechanical ventilation was shorter （Plt;0.05）. The concentrations of TNF-α and IL-6 in M+Z group and ZUF group were significantly lower than that in the MUF group an