静脉-静脉小流量膜肺治疗中超滤技术的应用  

Ultrafiltration Applied in Low Flow Venovenous Extracorpareal Membrane Oxygenation in Sheep

作　　者：甘小庄[1] 宋国维[1] 黄伟雄[1] 张琪[1] 李惠[1] 马广松[1] 孙丽萍[1] 张小伦[1] 

机构地区：[1]首都儿科研究所,北京100020

出　　处：《实用儿科临床杂志》2007年第18期1378-1380,共3页Journal of Applied Clinical Pediatrics

基　　金：卫生部国家科技攻关项目资助(2003BA712A11-10)

摘　　要：目的评价超滤技术在实验羊静脉-静脉(V-V)小流量膜肺治疗中清除尿素氮的效果和小流量膜肺治疗清除二氧化碳(CO2)和氧合的作用。方法绵羊16只。体质量(20±3)kg。麻醉后气管插管,应用呼吸机,分别于右颈内静脉和股静脉插管,调整呼吸机使实验羊窒息5～8min,建立高碳酸血症模型。随机将实验羊分为膜肺组和膜肺超滤组各8只。二组膜肺治疗的泵流速为30mL/(kg.min)。分别于治疗后30、60、90、120和180min从膜肺前后和股动脉取血做血气分析,测尿素氮,监测血压、心率和肛温等。结果膜肺和膜肺超滤组治疗前、后血压、心率和肛温均无显著差异(Pa>0.05)。二组治疗前股动脉血尿素氮分别为4.8±0.9和4.6±0.7mmoL/L;pH、pa(CO2)、pa(O2)分别为(7.168±0.062)和(7.168±0.085);(10.9±1.6)kPa和(10.8±1.5)kPa;(18.8±2.7)kPa和(18.1±6.7)kPa,二组各项均无显著差异(Pa>0.05)。治疗30、60、90和120min,膜肺组尿素氮基本不变,膜肺超滤组逐渐下降,但二组无显著差异,二组比较有显著差异(Pa>0.05);180min尿素氮分别为(4.9±0.7)和(4.0±0.6)mmoL/L,二组比较差异显著(P<0.05),膜肺超滤组较治疗前也显著下降(P<0.05);二组血pH上升为(7.368±0.040)和(7.342±0.078);pa(CO2)下降为(6.3±0.8)和(6.5±0.9)kPa;pa(O2)为(12.6±2.1)和(13.7±4.4)kPa,以上各项二组间均无显著差异(Pa>0.05)。膜氧合器后二组p(CO2)均较膜氧合器前显著下降,p(O2)和血氧饱和度(SO2)明显上升,但二组间无显著差异(Pa>0.05)。结论在V-V小流量膜肺治疗中超滤的应用能有效清除尿素氮但未造成血液分流,小流量静脉膜肺治疗有效排除CO2和进行氧合。Objective To evaluate the efficiency of ultrafiltration（UF）on removing blood urea nitrogen（BUN）and the effect of low flow venovenous（VV）,extracorporeal membrane oxygenation（ECMO）on eliminating carbon dioxide and oxygenation in sheep.Methods Sixteen sheep（20±3 kg）were tracheally intubated and ventilated after anesthesia with right internal jugular and femoral venous cannula.The sheep were in apnea for 5-8 min with hypercapnia after adjusting the settings of ventilator.They were randomized to ECMO group and ECMO and UF group.The flow rates of ECMO pump in two groups were 30 mL/（kg ·min）.The urea and blood gas analysis of samples from femoral artery,pre-oxygenator and post-oxygenator were measured at 30,60,90,120 and 180 min during procedures.The blood pressure,heart rate and body temperature were monitored.Results There were no significant differences in blood pressure,heart rate and body temperature between ECMO and ECMO and UF group Pa〉0.05.The urea were（4.8±0/9）and（4.6±0.7）mmoL/L ,pH,pa（CO2）,pa（O2）were（7.168±0.06）and（7.168±0.085）,（10.9±1.6）and（10.8±1.5）kPa,（18.8±2.7）和（18.1±6.7）kPa,respectively in pre-therapy.There were no significant differences between the two groups Pa〉0.05.Only at 180 min post-therapy,the BUN of ECMO group was（4.9±0.7）mmoL/L,compared with ECMO and UF group（4.0±0.6）mmol/L P〈0.05.There was also a significant difference between pre and post-therapy in later group,P〈0.05.The artery pH increased to（7.368±0.04）and（7.342±0.078）,pa（CO2）decreased to（6.3±0.8）and（6.5±0.9）kPa,pa（O2）were（12.6±2.1）and（13.7±4.4）kPa,respectively Pa〉0.05.p（CO2）was significantly lower,p（O2）and oxygen saturation of both groups in post-oxygenator were significantly higher than those in pre-oxygenator.There were no differences between the two groups Pa〉0.05.Conclusions The UF effectively removed BUN in sheep with low flow VV-ECMO.The application of UF didn＇t cause blood shunt in ECMO.Th

关 键 词：体外膜氧合作用 超滤 高碳酸血 绵羊 血气分析 

分 类 号：R720.597[医药卫生—急诊医学]