搏动灌注和非搏动灌注对肾功能的影响  

The impact of pulsatile and non-pulsatile perfusion on renal function in patients underwent cardiopulmonary bypass

作　　者：王少强[1] 魏松洋[1] 马志强[1] 郑庆杰[1] 祁延博[1] 

机构地区：[1]中国人民解放军第一五五中心医院胸心外科,开封475003

出　　处：《中国体外循环杂志》2011年第3期149-151,155,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的研究体外循环(CPB)时应用搏动灌注(PP)和非搏动灌注(NPP)对患者术后肾功能的影响。方法拟行CPB的患者60例,采用随机、双盲的方法分为搏动灌注组(PP组)和非搏动灌注组(NPP组),每组30例。PP组在人工心肺机泵后串联双搏动式心肺辅助装置,在主动脉阻断期间采用搏动灌注。NPP组全程均采用非搏动灌注。两组灌流量控制在2.3～2.8 L/(min .m2)。分别于术前(T1)、CPB后4 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)抽取外周静脉血及留取新鲜尿液,测定血清肌酐(Scr)、血清尿素氮(BUN)、血清β2-微球蛋白(β2-MG)和尿β2-MG浓度。结果两组患者一般资料差异无统计学意义。与T1比较,两组血清Scr、BUN浓度在T4～T5明显升高(P<0.01);血清β2-MG、尿β2-MG浓度在T2～T5明显升高(P<0.05)。与NPP组比较,PP组血清Scr、BUN浓度在T4～T5明显降低(P<0.05);血清β2-MG、尿β2-MG浓度在T2～T5明显降低(P<0.05)。结论 PP能有效地减轻CPB后肾脏损伤,降低肾功能损害的程度。OBJECTIVE To observe the influence of pulsatile perfusion（PP） and non-pulsatile perfusion（NPP） on renal function in patients underwent cardiopulmonary bypass（CPB）.METHODS Sixty low risk patients underwent CPB were divided in a double-blind and randomized fashion into 2 groups（n=30 each）： NPP group and PP group.In PP group,a twin pulse life support was used and the pulsatile flow was performed during the period of aortic cross-clamping.In NPP group,the non-pulsatile flow was used during CPB.In both groups,pump flow was set to 2.3-2.8 L/（min·m2）.Blood and urine samples were taken for determination the concentration of serum creatinine（Scr）,blood urea nitrogen（BUN）,plasma β2-microglobulin（β2-MG） and urinary β2-MG before CPB（T1）,and 2 h（T2）,12 h（T3）,24 h（T4）,48 h（T5） after cessation of CPB.Plasma β2-MG and urinary β2-MG were estimated by enzyme-linked immunoadsordent assay（ELISA）.RESULTS The two groups were comparable with respect to age,sex,stature,body weight,ejection fraction,accompanying diseases,operation type,the caliber of the arterial cannula,duration of CPB and aortic cross-clamping time.The concentrations of Scr and BUN at T4-T5 and the concentrations of plasma β2-MG and urinary β2-MG at T2-T5 were significantly increased comparing to the baseline values at T1 in both groups（P〈0.05）.The concentrations of Scr and BUN at T4-T5 and plasma β2-MG and urinary β2-MG at T2-T5 were significantly lower in PP group than in NPP group（P〈0.05）.CONCLUSION Pulsatile perfusion can reduce the injury of the renal tissues and suppress the decreasing degree of renal function.

关 键 词：搏动灌注 非搏动灌注 肌酐 尿素氮 血清Β2-微球蛋白 尿Β2-微球蛋白 

分 类 号：R654.1[医药卫生—外科学]