婴幼儿心脏手术后两种改良超滤方法对血流动力学的影响  

A comparative study of hemodynamics after cardiac surgery with venous-arterial modified ultrafiltration and aterialvenous modified ultrafiltration in infants

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体外循环科,上海201102

出　　处：《中华胸心血管外科杂志》2011年第7期412-415,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的评估先天性心脏患儿体外循环术后静脉-动脉改良超滤（V—AMUF）和动脉-静脉改良超滤（A-VMUF）两种方法对血流动力学的影响。方法40例患儿随机均分为两组，分别在体外循环术后行10min改良超滤。分别在体外循环前、体外循环后、体外循环后10、30min，记录心率、血压和中心静脉压血流动力学参数和血细胞压积。经食管超声心动图测定左心室后壁收缩期（LVPWs）和舒张期厚度（LVPWd）、舒张末期容积（EDV）、收缩末期容积（ESV）和射血分数（EF）并进行两组比较。结果V—AMUF患儿在体外循环术后10min和30min比术后即刻能维持更好的动脉收缩压。体外循环术后两组患儿EF均显著下降（P〈0．05）。V—AMUF组EF值在CPB术后10min（60％）和30min（46％）较CPB术后即刻显著升高（P〈0．001）。A—VMUF组EF值无上升。V—AMUF组左心室后壁厚度较A—VMUF有显著改善（P〈0．05）。两组在围术期血细胞压积差异无统计学意义。结论静脉-动脉改良超滤是一种安全有效改善患儿心脏术后血流动力学的方法。Objective Evaluate the effects of venous-arterial modified ultrafihration on hemodynamics compared to arterial-venous in children undergoing cardiopulmonary bypass （CPB） for repair of congenital heart defects. Methods Forty patients underwent MUF randomly divided into two groups,group V-A MUF （n =20） and group A-V MUF （n =20） for 10 min after CPB. They were studied before CPB, after CPB, 10 min after CPB, and 30 min after CPB. Haemodynamic data including heart rate, blood pressure, central venous pressure and hematocrit were recorded. Transoesophaegeat echocardiograpby determined left ventricular posterior wall thickness in end-systole （LYPWs） and end-diastole （LYPWd） , end diastolic volume （EDV）, end systolic volume （ESV） and ejection fraction （EF） were measured and compared in two groups. Results Patients in V-A MUF maintained better systolic arterial blood pressure at 10 min and 30 min compared with 0 rain values after CPB. A significant decrease in EF were observed in both groups immediately after CPB （ P 〈0.05 ）. Significant increase in EF was observed at lO min （60%） and 30 rain （46%） after CPB compared with 0 min value after bypass in V-A MUF （P 〈 0. 001 ）. In A-V MUF, no such increase in EF was observed. EF were significantly higher at 10 min and 30 min in V-A MUF as compared with A-V MUF （ P 〈 0. 001 ）. There was also significant improvement in posterior wall thickness in V-A MUF （ P 〈 0.05 ）. Haematocrit values were not different in duration of postoperative between two groups. Conclusion Veno-arterial modified ultrafiltration is a safe and effective method of improving hemodynamics in children following cardiac surgery.

关 键 词：心肺转流术 血流动力学 静脉-动脉改良超滤 动脉-静脉改良超滤 

分 类 号：R726.5[医药卫生—儿科]