婴儿心脏直视手术中两种超滤法应用对比探究.docVIP

婴儿心脏直视手术中两种超滤法应用对比探究 　 作者：陈萍，张镜方，章晓华，庄建，陈欣欣 【关键词】 心脏直视手术 摘要：目的 比较常规超滤（CUF）和CUF加改良超滤（MUF）在婴儿心脏直视手术中应用及效果。方法 选取40例单纯室间隔缺损（VSD）行修补术的婴儿随机均分为两组，C组采用CUF，M组采用CUF+MUF，两组用相同的方法进行体外循环（CPB）。观察：⑴CPB预充总量、手术总用血量、CPB总入量、红细胞压积（Hct）、超滤量、尿量、残血量等；⑵术前、术毕、术后4h、术后24h血浆白细胞介素（IL）-6，IL-8、肿瘤坏死因子（TNF-α）水平；⑶术后血管活性药物的应用、机械通气时间、ICU停留时间。结果 ⑴ 两组预充总量、手术总用血量、CPB总入量、尿量无统计学差异，超滤量M组（436±82）ml显著多于C组（347±57）ml， Plt;0.05；残血量M组（135±23）ml少于C组（168±32ml）, Plt;0.01；术毕Hct M组（0.36±0.04)高于C组（0.32±0.05）, Plt;0.05。⑵术毕TNF-αM组（97.6±18.4）pg/ml显著高于C组（83.1±16.5）pg/ml, Plt;0.05；余各时点、各指标2组间均无统计学差别。⑶术后血管活性药物的使用、机械通气时间、ICU停留时间2组间无显著差异，胸腔引流量M组（96.4±28.7）ml少于C组（117.3±32.6）ml，Plt;0.05；术后输血量（46.4±17.1）ml少于C组（61.5±25.0）ml，Plt;0.05。结论 与CUF相比，CUF+MUF应用于婴儿心脏直视手术可增加水分的排除、减少残血量及术后输血，但在减轻CPB炎性反应及提高ICU恢复方面未显示出更大的优势。 　　关键词：婴儿; 心脏直视手术; 超滤 　　The Comparison Between Conventional and Conventional plus Modified Ultrafiltration in Infant Open Heart Surgery 　　Abstract: OBJECTIVE To compare the effects of applying conventional ultrafiltration (CUF) and CUF plus modified ultrafiltration (MUF) during infant open heart surgery. METHODS 40 ventricular septum defect (VSD) infants undergoing repair were randomly divided into two groups, group C (CUF, n=20) and group M (CUF+MUF, n=20). Perioperative, cardiopulmonary, and cytokine datas were collected for statistical analysis.RESULTS ①There were no significant differences in priming volume and blood tranfusion during operation, total CPB add volume and urine volume between the two groups. The filtratevolume in group M was greater than in group C(436±82ml vs 347±57ml, Plt;0.05). Residual blood volume in group M was less than in group C(135±23ml vs 168±32ml, Plt;0.01). At the end of operation the Hct in group M was higher than in group C(0.36±0.04 vs 0.32±0.05, Plt;0.05). ②TNF-αin group M at the end of operation was significantly higher than in group C(97.6±18.4pg/ml vs 83.1±16.5 pg/ml, Plt;0.05). No differences existed in other cytokines between the two groups. ③There was no significant difference in th