含血预充液超滤技术在婴儿心脏手术中的应用  

Applications of Ultrafiltration of Priming Solution with Blood in Pediatric Cardiac Surgery

作　　者：钟慧[1] 梁雪村[1] 陈张根[1] 何春兰[1] 贾兵[1] 

机构地区：[1]复旦大学附属儿科医院心血管中心,上海201102

出　　处：《中国胸心血管外科临床杂志》2010年第6期450-454,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨体外循环(CPB)手术中含血预充液进行超滤洗涤后是否能使预充液达到生理状态,以及该方法对患者围术期电解质、酸碱平衡和心肺功能的影响。方法选取2009年2月至2009年6月在复旦大学附属儿科医院施行先天性心脏病手术治疗的40例患者,随机分为两组,实验组(n=20):男12例,女8例;年龄131.00±103.00 d,体重4.14±0.96 kg;术前利用CPB管道中血液超滤器对含血预充液进行超滤洗涤20 min。对照组(n=20):男11例,女9例;年龄127.00±88.00 d,体重4.38±1.05 kg;预充液在CPB管道中循环20 min。测定含血预充液洗涤前、后和患者围术期血气分析和电解质等指标;用超声心动图检测心功能指标包括短轴缩短率(FS),射血分数(EF)和心排血量(CO);观察肺功能变化。结果两组患者无死亡,均顺利出院。实验组呼吸机辅助呼吸时间显著短于对照组(2.7±0.3 d vs.4.1±0.4 d,P<0.05)。实验组含血预充液经洗涤超滤后的各项指标均达到正常值范围,pH值升高(从6.89±0.22升至7.40±0.57,P=0.001),BE值升高(从-16.12±0.98 mmol/L上升至+0.31±2.40 mmol/L,P=0.000),钾离子浓度降低(从10.33±2.13 mmol/L降至4.27±0.93 mmol/L,P=0.000);白细胞介素-8浓度降低(从78.40±6.10 pg/ml下降至64.30±48.10 pg/ml,P=0.036);缓激肽浓度降低(从5 982±1 353pg/ml下降至531.00±35.00 pg/ml,P=0.031)。实验组FS、EF和CO术后下降幅度均小于对照组,术后4 h实验组CO显著高于对照组(2.77±0.95 L/min vs.1.66±0.75 L/min,P=0.001);术后24 h实验组EF高于对照组(67.44%±6.89%vs.61.17%±9.02%,P=0.003)。术后6 h两组肺泡-动脉血氧分压差(A-aDO2)和呼吸指数(RI)显著上升(P<0.05),然后开始逐渐下降恢复至术前水平。实验组趋向于更早开始恢复肺功能。术后48 h,实验组A-aDO2和RI明显低于对照组(P<0.05)。结论对含血预充液进行洗涤超滤可使CPB预充液更符合生理状态,减少炎性介质,改善婴幼儿术后心肺功能,这对新生儿和小婴�Objective To discuss whether priming solution with blood can reach a physiologic state after ultrafiltration and investigate the influence of this method on electrolytes,acid-base balance and cardiopulmonary function in patients in perioperative period. Methods Forty patients with congenital heart diseases treated in our hospital from February to June 2009 were enrolled in this study.The weight of these patients was less than 8 kg.They were randomly divided into two groups： the experimental group（n=20,12 males and 8 females;age： 131.00±103.00 d;weight： 4.14±0.96 kg） and the control group（n=20,11 males and 9 females;age： 127.00±88.00 d;weight： 4.38±1.05 kg）.For patients in the experimental group,the priming solution was filtered with a blood ultrafilter in the cardiopulmonary bypass（CPB） circuit for twenty minutes,while the priming solution circulated in the CPB circuit without filtration for patients in the control group before operation.Data were obtained from the priming solution before and after ultrafiltration.Blood gas analysis was done and indexes like the electrolytes were detected during the operation.Fractional shorting（FS）,ejection fraction（EF） and cardiac output（CO） were measured by echocardiography.Pulmonary function change was also observed.Results No death occurred in both groups.Mechanical ventilation time for the experimental group was significantly shorter than that of the control group（2.7±0.3 d vs.4.1±0.4 d,P0.05）.After ultrafiltration for the experimental group,all indexes of the priming solution reached normal values： pH increased（from 6.89±0.22 to 7.40±0.57,P=0.001）;base excess increased（from-16.12±0.98 mmol/L to ＋0.31±2.40 mmol/L,P=0.000）;potassium concentration decreased（from 10.33±2.13 mmol/L to 4.27±0.93 mmol/L,P=0.000）;interleukin-8（IL-8） decreased（from 78.40±6.10 pg/ml to 64.30±48.10 pg/ml,P=0.036）;and bradykinin decreased（from 5 982±1 353 pg/ml to 531.00±35.00 pg/ml,P=0.031）.The decrease of FS,EF and CO

关 键 词：血液滤过 含血预充液 体外循环 婴幼儿 心脏手术 

分 类 号：R726.5[医药卫生—儿科]