超滤对心肺转流瓣膜置换术患者血液流变学的影响  

Effects of ultrafiltration on blood rheology in patients undergoing valve replacement with cardiopulmonary bypass

作　　者：张红[1] 李佩[1] 窦雪娇[1] 张琼[1] 蔡回钧[1] 丁珺[1] 

机构地区：[1]遵义医学院附属医院麻醉科,563003

出　　处：《临床麻醉学杂志》2014年第2期146-149,共4页Journal of Clinical Anesthesiology

基　　金：贵州省社会发展科技攻关项目(黔科合SY字[2008]3030)

摘　　要：目的探讨心肺转流(CPB)中超滤对瓣膜置换术患者血液流变学的影响。方法选择需在CPB下行瓣膜置换术的患者40例,随机均分为两组:无超滤组(W组)和超滤组(UF组)。两组患者均采用静-吸复合麻醉,开胸后建立CPB。W组:CPB中不进行超滤;UF组:CPB复温至32℃时开始超滤,直至停机。两组患者分别于术前(T0)、升主动脉阻断后10min(T1)、UF组在超滤时/W组在鼻咽温复温至32℃时(T2)、停机时(T3)、术后24h(T4)和术后36h(T5)采集动脉血检测血浆粘度(PV)、红细胞刚性指数(IR)、变形指数(TK)和聚集指数(Agrbc);同时行动脉血气分析并计算氧合指数(OI)、呼吸指数(RI);记录CPB时间、升主动脉阻断时间、手术时间、超滤液量;术后随访并记录患者的住院天数、ICU时间、术后拔管时间、输血量、引流量和尿量的情况。结果与T0时比较,两组T1～T3时PV明显降低(P<0.05);T1～T5时IR、TK、Agrbc明显降低(P<0.05)。与T2时比较,UF组T3～T5时IR、TK、Agrbc明显升高(P<0.05)。与T0时比较,两组患者T1、T3时OI明显增大,RI明显减小,T4、T5时OI明显减小,RI明显增大(P<0.05)。与W组比较,UF组T5时OI明显增大,RI明显减小;UF组患者ICU时间、术后拔管时间、术后输血量均明显减少(P<0.05)。结论超滤可改善CPB后的肺功能,有利于瓣膜置换术后患者的恢复;而对红细胞的流变学无明显影响。Objective To investigate the effect of ultrafiltration on hemorheology of patients undergoing valve replacement with cardiopulmonary bypss （CPB）. Methods Forty patients undergoing valve replacement were randomly divided into 2 groups： without ultrafitration group （group W） and ultrafitration group （group UF）. Intravenous-inhalation anesthesia was used in all patients. CPB was established after thoracotomy. Ultrafiltration was not administrated in group W. In group UF, ultrafihration was enforced when the nasopharyngeal temperature rewarmed to 32℃ until the end of CPB. Arterial blood samples were collected for indexes related with hemorheology and blood gas analysis for the measurement of oxygenation index（OI）, respiratory index （RI） at the following time points： before the operation （T0）, 10 min after the blocking of ascending aorta （T1）, when the nasopharyngeal temperature recovered to 32℃ （T2）, at the end of CPB（Ta）, and 24 h and 36 h after the surgery （T4 ,Ts）. Duration of CPB, aortic clamp time, operation time and the amount of ultrafiltrate were recorded. In postoperative follow-up, the duration of hospitalization, the length of stay in ICU, duration of intubation, and the volumes of blood transfusion, drainage and urine were quantified. Results Compare with To, PV was significantly lowered at T1-T3 （P〈0.05） ; IR, TK and Agrbc decreased dramatically at T1-Ts （P%0.05）. IR, TK and Agrbc of group UF at T3-Ts increased compared with T2 （P%0.05）.Compare with To, OI significantly increased and RI decreased at T1 and T3; OI and RI were with opposite changes at T, and Ts （P %0.05）. OI in group UF increased and RI decreased compared with group W at T1 （P%0.05）. The stay of ICU, duration of intubation, and volume of blood transfusion in group UF were significantly decreased （P %0.05）. Conclusion Ultrafihration can protect lung function against CPB and is beneficial to rehabilitate the patients without influence on rheology of erythrocytes.

关 键 词：心肺转流 超滤 血液流变学 瓣膜置换术 

分 类 号：R614[医药卫生—麻醉学]