心肺转流中不同超滤量对心脏瓣膜替换术后乳酸水平和呼吸功能的影响  

The effect of different volume of ultrafiltrations on lactic acid level and respiratory function after cardiopulmonary bypass

作　　者：贾在申[1] 刘瑞芳[1] 孙志全[1] 刘晓军[1] 李砚平[1] 柳薇[1] 李蛟[1] 王征[1] 侯晓彤[1] 

机构地区：[1]首都医科大学附属北京安贞医院体外循环科,北京市100029

出　　处：《临床麻醉学杂志》2010年第11期928-930,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察心肺转流(CPB)中不同超滤量对心脏瓣膜替换术后乳酸水平和呼吸功能的影响。方法 60例择期心脏瓣膜替换术患者在CPB复温后进行常规和平衡超滤,根据平衡超滤量的不同均分为三组:低容量超滤组(A组),超滤液量为30ml/kg;中容量超滤组(B组),超滤液量为50ml/kg;高容量超滤组(C组),超滤液量为70ml/kg。分别于麻醉诱导后(T1)、超滤前(T2)、CPB停机时(T3)、术后6h(T4)、24h(T5)监测患者的乳酸浓度,并于T1～T4时监测肺功能。结果 CPB开始后患者血浆乳酸有所升高,T4时达到峰值(P<0.05);T3、T4时B、C组明显低于A组(P<0.05)。T4时肺动态顺应性(CD)B、C组明显高于A组(P<0.05)。与T1时比较,T3、T4时三组氧合指数(OI)升高、肺泡动脉氧分压差[PA-aDO2]降低,但差异无统计学意义。结论中等容量平衡超滤(50ml/kg)可降低瓣膜替换患者术后血浆乳酸浓度,改善术后通气功能,对瓣膜病患者术后肺功能恢复有一定促进作用。Objective To evaluate the effects of different volume of balance ultrafiltrations on lactic acid level and respiratory function in adult valvular replacement surgery after cardiopulmonary bypass （CPB）.Methods Sixty patients undergoing valvular replacement surgeries were randomly divided into three groups according to the volume of ultrafiltration：group A（30 ml/kg）,B（50 ml/kg） and C（80 ml/kg）. Serum lactic acid and pulmonary function were monitored after induction of anesthesia（T1）,shortly before ultrafiltration （T2）,at the end of CPB（T3）,6 hours （T4）,and 24 hours after surgery （T5）.Results The levels of lactic acid increased in all groups at T1 and peaked at T4. It deceased with the volume of ultrafiltration at T3 and T4. Lactic acid in group B and group C were significantly lower than that of group A at T3 and T4 （P0.05）. The pulmonary compliance decreased after surgery and it was higher in group B and group C than that of group A （P0.05）. Oxygenation indexes were increased but the alveolo-arterial oxygen partial pressure difference were decreased in three groups at T3 and T4 （P0.05）.Conclusion Balanced ultrafiltration with 50 ml/kg can decrease serum lactic acid and improve respiratory function.

关 键 词：心肺转流 平衡超滤 乳酸 呼吸功能 

分 类 号：R654.2[医药卫生—外科学]