超滤在婴儿先天性心脏病手术中应用探究.docVIP

超滤在婴儿先天性心脏病手术中应用探究 　 作者：杨盛春，林植民，吕回，曾华松，周伟，张永健，刘威，夏圆生，张志意，曾其毅 【摘要】 目的了解婴儿先天性心脏病（简称先心病）合并肺动脉高压体外循环手术前后内皮素（ET）、血栓素B2（TXB2）血浆浓度和肺动脉压（以肺体循环收缩压比衡量，SPAP/SBP=肺动脉收缩压/血压收缩压）的变化及应用超滤对这种变化的影响。方法选择20例进行体外循环手术的室间隔缺损合并肺动脉高压的婴幼儿，在手术中随机将患儿分为二组。一组为实验组，在手术过程中进行超滤；另一组为对照组，手术过程中不超滤。观察二组患儿手术前后SPAP/SBP和TXB2、ET血浆浓度变化的异同。结果二组患儿术后TXB2、ET血浆浓度在手术开始后均显著升高，手术结束后及术后3 h显著下降，TXB2术后早期（术后3 h）超滤组下降较对照组更为明显，有显著性差异（P＜0.05）；二组SPAP/SBP在术后及术后3 h有显著下降，而超滤组下降更为明显，有显著性差异（P＜0.05）。结论超滤在婴儿先心病合并肺动脉高压体外循环手术中的应用能使术中升高的TXB2血浆浓度在术后早期更快下降；也能使肺动脉压在术后早期下降更快。 【关键词】 超滤；先天性心脏病；肺高压；血栓素B2；内皮素 　　The Application of Ultrafiltration in the Operation of Infants with Congenital Heart Defects Complicated by Pulmonary Hypertention 　　Abstract: OBJECTIVE To study the perioperative changes of pulmonary pressure and the thromboxane B2 （TXB2）、endothelin（ET）concentration in plasma of the infants with congenital heart defect complicated by pulmonary hypertention and the influences of ultrafiltration on these changes.METHODSSelected 20 infants with congenital heart defects randomly divided into two groups,one group used ultrafiltration and the other not while they were operated with cardiopulmonary bypass;the different perioperative changes of pulmonary pressure and the TXB2、ET concentration in plasma were observed in the two groups.RESULTSAfter the operations began,the TXB2、ET concentration in the two groups rised sharply,at the end of operations and postoperative 3 hours,the pulmonary pressure and the TXB2、ET concentration in the two groups decreased but in the ultrafiltration group is sharper.CONCLUSIONWhile applicating ultrafiltration during operations with cardiopulmonary bypass ,the rised pulmonary pressure and the TXB2 concentration in plasma of the infants with congenital heart defects complicated by pulmonary hypertention will decrease more sharply after the operations. 　　Key words：Ultrafiltration；Congenital heart disease；Pulmonary hypertention；Thromboxane B2;Endothelin 　　超滤在心脏病体外循环手术中的应用越来越广泛,但在婴儿先心病合并肺动脉高压体外循环手术中，超滤的应用研究报告却较少。本研