婴幼儿心脏手术围体外循环期间胶体渗透压变化.docVIP

婴幼儿心脏手术围体外循环期间胶体渗透压变化 　 作者：赵举，龙村，李桂芬，冯正义，杨九光，梁凤玲 【摘要】 目的 探讨婴幼儿心脏手术围体外循环（Extracorporeal circulation，ECC）期血浆胶体渗透压（COP）的变化特点及ECC期间不同干预措施对COP的影响。方法 30例在ECC下行心脏直视手术的婴幼儿，体重小于10 kg，随机分为对照组（C组，n=10）、常规超滤组（CUF组，n=10）、改良超滤组（MUF组，n=10），观察不同时点（预充液、手术前、ECC前、ECC中、ECC后、ICU 2 h、ICU 24 h）的血浆COP，寻找ECC期间COP的变化趋势，评价不同超滤方法对围体外循环期间COP的影响。结果 ECC预充液COP显著低于患儿术前水平（Plt;0.01）；由于ECC预充成分的影响ECC开始后COP明显下降（Plt;0.05）；ECC后COP恢复至ECC前水平（Pgt;0.05）；ICU 2 h和24 h患儿COP维持正常生理偏高水平。CUF组在ECC期间COP略高于C组但无显著性差异（Pgt;0.05），MUF组COP在ECC后均显著优于C组和CUF组（Plt;0.05）。结论 ECC术中血浆COP明显下降。CUF可以提高ECC期间的COP，但效果不够理想；MUF是提高术后COP的有效手段。 【关键词】 体外循环；婴幼儿；血浆胶体渗透压；超滤 　　The Tendency of Plasma Colloid Osmotic Pressure in Infants Undergoing CPB Heart Surgery 　　Abstract: OBJECTIVE To observe the variance of plasma colloid osmotic pressure (COP) in infants underwent extracorporeal circulation（ECC） heart surgery and evaluate the influence of different ultrafiltrations on COP of infants. METHODS 30 infant patients undergoing the ECC heart surgery were randomly divided into 3 groups: control group (C, n = 10), conventional ultrafiltration group (CUF, n = 10) and modified ultrafiltration group (MUF, n = 10). COP of blood samples in 7 points (prime solution、pre-surgery、pre-ECC、in-ECC、post-ECC、ICU 2 hours and ICU 24 hours) from patients were tested. Looking for the tendency of COP changing and effects of the ultrafiltration on COP in infants. RESULTS The significant difference of COP was found between prime solution and pre-CPB (Plt;0.01). The COP after CPB beginning decreased (Plt;0.05) because of the influence of prime solution. COP of post-ECC increased to the level of pre-ECC(Pgt;0.05) in all groups. Patients’ COP in ICU maintained the normal high levels at 2hours and 24hours. CUF can make COP higher than C group but it was not of significance. MUF group had the significantly higher COP than C group and CUF group after ECC(Plt;0.01). CONCLUSION The COP of patients went to the lower level during ECC. CUF is not the effective method to increase th