改良超滤在重症心脏瓣膜替换术中的应用  

Clinical application of improved ultrafiltration in severe heart valve replacement with cardiopulmonary bypass

作　　者：岳琴[1] 张近宝[1] 邬晓臣[1] 辛梅[1] 欧阳辉[1] 梁瑜[1] 刘小燕[1] 魏小红[1] 

机构地区：[1]成都军区总医院心胸外科,四川成都610083

出　　处：《四川医学》2010年第12期1766-1768,共3页Sichuan Medical Journal

摘　　要：目的探讨改良超滤在重症心脏瓣膜置换术体外循环(extracorporeal circulation,ECC)中的应用价值。方法 2009年1月～11月我院共行心脏瓣膜置换术165例。随机分为改良超滤(MUF)组(n=89)和无超滤对照组(n=76),动态观察体外循环(CPB)前、CPB停时及MUF结束时(对照组为CPB停后15min)3个时间点心排量(CO)、心排指数(CI)等心功能指标。结果 MUF组患者超滤时间为35～115min,滤出液量600～1800ml。所有患者在停ECC时血细胞比容得到提高(>28%),关胸时术野渗血明显减少,MUF组超滤后CO、CI均较CPB停时明显升高(P<0.05);对照组停CPB时与CPB停后15min相比,各项指标差异无统计学意义。MUF组超滤结束后与对照组CPB停后15min相比,CI升高显著(P<0.05)。且MUF组患者术后肺部并发症减少,呼吸机辅助时间6～10h,对照组呼吸机辅助时间8～18h,在重症监护室住院时间MUF组为2～4d,对照组为3～6d。结论 ECC中应用改良超滤方法可迅速排除体内过多的水分和中小分子炎性因子等有害成分,能迅速浓缩血液,同时减轻患者术后各脏器水肿,减少术后各脏器并发症,有利于心、肺及全身各脏器功能的恢复,提高手术的安全性,降低患者监护室住院时间。Objective To study the clinical application of improved ultrafiltration in severe heart valve replacement with extracorporeal circulation（ECC）.Methods From January to December of 2009.165 cases of severe heart valve replacement were randomly dividing into two groups：MUF group with improved ultrafiltration in ECC（n=89）and control group（n=76）without improved ultrafiltration.The time course of ultrafiItration was in the rewarming period or before.The index of CO and CI at time of pre-CPB,end-CPB,and post-MUF（or 15 min post-CPB in control group）were measured.Results In the MUF group,the period of ultrafiltration was 35~115 min with 600~1800 ml filtration out to make the HCT up 28%.And in the MUF group,CO and CI at post-MUF increased significantly compared with those en-CPB（P0.05）：In MUF group CI was significantly higher at post-2MUF point than those in control group at 15 min post-CPB（P0.05）.Conclusion Ultrafiltration can quickly filter out the supernumerary water,decrease the inflammatory mediators,concentrate the blood and improve the function of organs after operations especially the left ventricular systolic function and diastolic compliances.improve cardiac index and cardiac function.It′s useful to improve the security of operations.

关 键 词：改良超滤 瓣膜置换术 体外循环 

分 类 号：R654.2[医药卫生—外科学]