改良超滤联合常规超滤对重症瓣膜病患者瓣膜置换术后肺保护的作用  

Protective effect of modified ultrafiltration combined with conventional ultrafiltration on pulmonary function in patients with severe valve disease after heart valve replacement surgery

作　　者：袁从虎[1] 张亚军[2] 宋建祥[2] 于广东[1] 钱静[1] YUAN Conghu;ZHANG Yajun;SONG Jianxiang;YU Guangdong;QIAN Jing(Department of Anesthesiology,Yancheng Third People's Hospital,Yancheng 224001;Department of Cardiothoracic Surgery,Yancheng Third People's Hospital,Yancheng 224001,China)

机构地区：[1]盐城市第三人民医院麻醉科,224001 [2]盐城市第三人民医院心胸外科,224001

出　　处：《国际心血管病杂志》2021年第1期48-52,共5页International Journal of Cardiovascular Disease

基　　金：江苏省高层次卫生人才“六个一工程”拔尖人才科研项目(LGY2017045)。

摘　　要：目的:探讨改良超滤联合常规超滤技术对体外循环瓣膜置换术后肺损伤的改善作用。方法:纳入102例行瓣膜置换术的重症瓣膜病患者,分为常规超滤组(CUF组)和常规超滤联合改良超滤组(CMUF组),两组在体外循环(CPB)中均进行常规超滤,CMUF组在转流结束后进行改良超滤直至机血全部回输体内。分别于诱导后(T1)、常规超滤开始(T2)、常规超滤结束(T3)、改良超滤开始(T4)、改良超滤结束(T5)、CPB后2 h (T6)、CPB后8 h(T7)、CPB后24 h(T8)采集动脉血行血气分析并测定白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、红细胞压积(HCT)水平。计算T1、T5-8时氧合指数、肺泡-动脉血氧分压差、肺静态顺应性,记录气道压、术后呼吸机支持时间、ICU停留时间及住院总时间。结果:两组IL-6、TNF-α、HCT水平在改良超滤开始(T4)前均无统计学差异,CMUF组改良超滤结束(T5)后血浆IL-6、TNF-α水平显著低于CUF组,红细胞压积、氧合指数、肺静态顺应性较CUF组升高,肺泡-动脉血氧分压差、气道压较CUF组降低(P均<0.05)。CMUF组术后24 h尿量、术后呼吸机辅助时间、ICU停留时间及住院时间均明显低于CUF组(P均<0.05)。结论:在重症瓣膜病患者体外循环中联合常规超滤和改良超滤,能有效浓缩血液,减轻炎性反应,改善瓣膜置换术后肺功能。Objective:To investigate the effect of conventional ultrafiltration combined with modified ultrafiltration on lung injury after cardiopulmonary bypass(CPB).Methods:A total of 102 patients with severe valvular disease were divided into conventional ultrafiltration(CUF)group and conventional ultrafiltration combined with modified ultrafiltration(CMUF)group.CUF was performed during CPB in both groups.After bypass,modified ultrafiltration(MUF)was instituted until residual CPB circuit blood was infused back to the body.Arterial blood samples were collected after induction(T1),before CUF(T2),after CUF(T3),before MUF(T4),after MUF(T5),as well 2 hours(T6),8 hours(T7)and 24 hours(T8)after CPB for blood gas analysis and determination of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and hematocrit(HCT).The oxygenation index,alveolar-arterial oxygen partial pressure difference(A-aDO2),static pulmonary compliance at T1,T5,T6,T7,and T8 were calculated;airway pressure,postoperative ventilator support time,ICU stay and total hospital stay time were recorded.Results:There was no statistical significant difference in the levels of IL-6、TNF-αand HCT between the two groups before MUF(T4).After MUF(T5),the concentrations of plasma IL-6 and TNF-α,as well as A-aDO2 and airway pressure in the CMUF group were significantly lower than those in the CUF group,and the levels of HCT,oxygenation index and static pulmonary compliance were higher(all P<0.05).Compared with CUF group,postoperative 24 hours urine volume in CMUF group was less,and postoperative ventilator assisted time,ICU stay and hospital stay time in CMUF group were significantly shorter(all P<0.05).Conclusions:The combination of CUF and MUF during CPB in patients with severe valvular disease can effectively concentrate blood,reduce inflammatory reaction and improve pulmonary function.

关 键 词：体外循环 肺功能 改良超滤 心脏外科 

分 类 号：R654.2[医药卫生—外科学]