改良超滤与零平衡超滤对高风险心脏瓣膜置换术患者术后心肺功能的影响  

Comparison of modified and zero-balance ultrafiltration on postoperative cardiac and pulmonary function of high risk patients underwent heart valve replacement operation

作　　者：俞瑾[1] 詹海婷[1] 李帆[1] 苟伟挺 王江[1] 郑宏[1] Yu Jin Zhan Hai-ting Li Fan Gou Wei-ting Wang Jiang Zheng Hong(Department of Anaesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, Chin)

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐830054

出　　处：《中国体外循环杂志》2017年第3期144-147,共4页Chinese Journal of Extracorporeal Circulation

基　　金：新疆维吾尔自治区科技支撑计划项目(201533102)

摘　　要：目的比较改良超滤与零平衡超滤对高风险心脏瓣膜置换术患者术后心肺功能的影响。方法 90例高风险心脏瓣膜病患者用随机数字表法分为两组,改良超滤组(MUF组)和零平衡超滤组(ZUF组),每组45例。比较两组患者主动脉阻断时间、超滤时间、超滤总量、术中输血量,观察体外循环(CPB)前、CPB后,改良超滤结束后氧分压(PO_2)与二氧化碳分压(PCO_2)、红细胞比容(Hct)、肿瘤坏死因子-α(TNF-α)和白细胞介素6(IL-6)的变化;术后观察指标包括术后呼吸机辅助时间、ICU停留时间、术后一周左心室射血分数、多巴胺用量与持续时间、术后24 h心肌酶谱与肌钙蛋白I、肌钙蛋白T的变化。结果 90例患者均顺利完成手术,MUF组超滤时间和滤液总量少于ZUF组(P<0.05),术中需要输入悬浮红细胞的量少于ZUF组(P<0.05);MUF组患者超滤结束后PO_2与Hct显著高于ZUF组,PCO_2两组间无差异;TNF-α与IL-6在CPB结束与超滤结束后ZUF组低于MUF组(P<0.05);MUF组术后呼吸机辅助时间、多巴胺用量与多巴胺使用时间上均短于ZUF组(P<0.05)。结论虽然零平衡超滤可以降低炎性因子水平,但改良超滤较零平衡超滤更适用于高风险心脏瓣膜置换术患者,可以明显增加术后PO_2与Hct水平、减少术中输血量,缩短术后呼吸机辅助时间、多巴胺用量与多巴胺使用时间。Objective To determine the protective effects of modified ultrafiltration and zero-balanced ultrafiltration on postoperative cardiac and pulmonary function of high risk patients underwent heart valve replacement operation.Methods Ninety high risk patients with heart valve diseases were randomly divided into 2 groups：modified ultrafiltration group （MUF group） and zero-balanced ultrafiltration group （ZUF group）.The following indicators were compared between 2 groups,including aortic aortic clamping time,ultrafiltration time and total volume,transfusion volume during operation,the oxygen partial pressure （PO2）,carbon dioxide partial pressure （PCO2）,hematocrit （Hct）,tumor necrosis factor alpha （TNF-alpha） and interleukin 6 （IL-6） concentration before cardiopulmonary bypass （CPB）,after CPB and after ultrafiltration,the duration of postoperative mechanical ventilation and ICU stay,left ventricular ejection fraction one week after the surgery,dopamine dosage and duration,myocardial enzymes and troponin I,troponin T changes at postoperative 24 h.Results All patients were successfully completed surgery.Compared with ZUF group,time and total volume of ultrafiltration as well as red blood cell transfusion volume during operation were lower in MUF group （P〈0.05）;PO2 and Hct in MUF group were significantly higher than those in ZUF group after ultrafiltration,there was no difference between two groups at PCO2.TNF-α and IL-6 of ZUF group were lower than MUF group after CPB and after ultrafiltration （P〈0.05）;the duration of mechanical ventilation,dosage and duration of dopamine uesd after operation in MUF group were shorter than ZUF group （P〈0.05）.Conclusion Although ZUF could reduce the levels of inflammatory factors,MUF is more suitable for high risk patients underwent heart valve replacement operation,MUF can significantly increase the postoperative PO2 and Hct level,reduce intraoperative blood transfusion,shorten the duration of mechanical ventilation,dosage and duration o

关 键 词：改良超滤 高风险 心脏瓣膜置换 

分 类 号：R654.2[医药卫生—外科学]