两种不同超滤置换液在患儿大容量零平衡超滤中的比较  

Comparison of High Volume Zero-Balanced Ultrafiltration With Different Replacement Fluid in Infant Patients

作　　者：曹凡 黄国栋 袁惠莉 白楠 王怀贞 陈欣欣 

机构地区：[1]广州市妇女儿童医疗中心心脏中心,广东省510623 [2]广州市妇女儿童医疗中心麻醉科,广东省510623

出　　处：《中国循环杂志》2014年第11期917-920,共4页Chinese Circulation Journal

摘　　要：目的：比较两种不同置换液在患儿大容量零平衡超滤（ZBUF）中的效果。 方法：2012-11至2014-02选取主动脉缩窄深低温停循环手术的患儿40例，随机分为勃脉力A置换液组（n=21）和改良置换液组（n=19），均在复温阶段以15~20 ml/kg流量行ZBUF，直至直肠温34℃停止。分别于转机前（T1），开放升主动脉并补充完Ca剂之后5分钟（T2），ZBUF结束（T3），停机后（T4）检测血气。记录术中体外循环相关时间，观察并发症及术后恢复情况。 结果：两组术中血气结果比较：T3时改良置换液组患者的血气Ca离子浓度明显高于勃脉力A置换液组（P〈0.01），碱剩余于T3时均呈负数且绝对值改良置换液组明显小于勃脉力A置换液组（P〈0.05），而T1，T2，T4差异均无统计学意义（P〉0.05）；其余各项指标组间比较差异均无统计学意义（P〉0.05）。两组术后恢复指标均无统计学差异（P〉0.05）。 结论：使用改良置换液较勃脉力可显著避免钙离子浓度降低和酸中毒，能为患者提供相对稳定的内环境。Objective：To compare the clinical effects of high volume zero-balanced ultraifltration （ZBUF） with different replacement lfuid in infant patients. Methods： A total of 40 infant patients who received aortic coarctation with deep hypothermic circulatory arrest operation in our hospital from 2012-11 to 2014-02 were summarized. The patients were randomized into 2 groups, Group A, the patients had ZBUF with plasmalyte A, n=21 and Group B, the patients had ZBUF with modiifed replacement lfuid n=19. All patients received ZBUF （15-20） ml/kg during re-warming period until the temperature reached 34°C at rectum. Blood gas analysis were conducted at 4 time points as T1 （before CPB）, T2 （open ascending aorta and 5 min after calcium perfusion）, T3 （ifnishing ZBUF） and T4 （end of CPB）. The intra-operative CPB time and the post-operative recovery with the complication were recorded in all patients. Results： For blood gas analysis, the calcium concentration was higher in Group B than that in Group A at T3 time point, P〈0.01 and the base excess was higher in Group A than that in Group B at T3 time point, P〈0.05. Those indexes were similar at T1, T2 and T4, all P〉0.05. The other indexes were similar between 2 groups, P〉0.05 and the post-operative recovery was similar between 2 groups, P〉0.05. Conclusion： ZBUF with modiifed replacement lfuid could avoid decreased calcium concentration and acidosis, therefore, provide a relative stable homeostasis in infant patients.

关 键 词：零平衡超滤 勃脉力A 体外循环 

分 类 号：R54[医药卫生—心血管疾病]