静脉-动脉改良超滤在Stanford A型主动脉夹层手术的应用  

Application of veno-arterial modified ultrafiltration in cardiopulmonary bypass during Stanford type A aortic dissection surgery

作　　者：彭勤宝 林天晓 陈星 孟维朋 官莉[1] 郑少忆[1] PENG Qin-bao;LIN Tian-xiao;CHEN Xing;MENG Wei-peng;GUAN Li;ZHENG Shao-yi(Department of Cardiovascular surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院心血管外科,广州市510515

出　　处：《中国心血管病研究》2021年第8期682-687,共6页Chinese Journal of Cardiovascular Research

基　　金：广东省医学科学技术研究基金(B2021025)。

摘　　要：目的探讨静脉-动脉改良超滤(VA-MUF)在Stanford A型主动脉夹层(TAAD)手术中的临床效果。方法回顾性分析2018年1月至2021年3月南方医科大学南方医院心血管外科接受手术治疗的TAAD患者81例,其中在体外循环(CPB)中应用VA-MUF(MUF组)32例,采用常规超滤(CUF组)49例。记录并比较两组的在麻醉诱导后(T1)、体外循环结束(T2)、返ICU即刻(T3)、术后6 h(T4)、术后12 h(T5)和术后24 h(T6)等不同时点的红细胞比积(HCT)和血清乳酸值(Lac)等血气指标,对比两组的体外循环时间、主动脉阻断时间、转流中的尿量、出入量和红细胞用量及术后早期各项恢复指标。结果与CUF组相比,MUF组在CPB中超滤量更多[(8268.8±2132)ml比(7185.7±2105.4)ml,P=0.027],转中负平衡更明显[(-3509.3±1872)ml比(-2598.4±1708.8)ml,P=0.027],术后24 h引流量更少[(547.4±124.3)ml比(715.1±96)ml,P<0.01],监护室停留时间更短[(5.7±1)d比(6.4±1.1)d,P=0.003],在时点T3、T4、T5的HCT更高(均P<0.01)。其余各临床指标两组间无显著性差异。结论在Stanford A型主动脉夹层手术中应用VA-MUF技术相对安全、可行,不增加体外循环时间、在一定程度上有利于减少术后出血并促进患者早期恢复。Objective To investigate the clinical outcomes of venoarterial modified ultrafiltration(VA-MUF) in Stanford type A aortic dissection(TAAD) surgery. Methods The data of 81 patients with TAAD treated surgically in the Department of Cardiovascular Surgery, Nanfang Hospital of Southern Medical University from January 2018 to March 2021 were reviewed, in which 32 patients were treated with modified ultrafiltration(MUF group) and 49 patients with conventional ultrafiltration(CUF group) in cardiopulmonary bypass(CPB).Parameters such as hematocrit(HCT) and serum lactate level(Lac) were recorded and compared between the two groups at different points including after induction of anesthesia(T1), at the end of CPB(T2), immediately returning to the ICU(T3), 6 h、12 h and 24 h respectively back to ICU(T4~T6).The CPB time,the aortic crossclamp(ACC) time, urine volume, intake and output volume, erythrocyte consumption and various recovery indicators in the early postoperative period were also comparatively analyzed. Results Compared to the CUF group, the MUF group had a higher ultrafiltration volume in CPB [(8268.8±2132) ml vs.(7185.7±2105.4) ml, P=0.027], a more significant negative body fluid balance [(-3509.3 ± 1872) ml vs.(-2598.4 ± 1708.8) ml, P=0.027];The postoperative 24 h drainage was less [(547.4±124.3) ml vs.(715.1±96) ml, P<0.01] and the length of stay in the intensive care unit was shorter [(5.7 ± 1) d vs.(6.4 ± 1.1) d, P=0.003];HCT at time points T3, T4 and T5 was higher(all P<0.01). The remaining clinical indicators were not significantly different between the two groups.Conclusion The VA-MUF technique is relatively safe and feasible to apply in TAAD surgery. It does not increase the CPB time and to some extent helps to reduce postoperative bleeding and promote early recovery of patients.

关 键 词：改良超滤 主动脉夹层 全弓置换 体外循环 

分 类 号：R543.1[医药卫生—心血管疾病]