胶体渗透压对婴儿体外循环术后恢复的影响  

Effects of colloid osmotic pressures on postoperative recovery of infants during cardiopulmonary bypass

作　　者：叶明棠 莫绪明[1] 丁培成 陈凤 郁迪[1] 丁杰 Ye Mingtang;Mo Xuming;Ding Peicheng;Chen Feng;Yu Di;Ding Jie(Department of Cardiothoracic Surgery,Affiliated Children's Hospital,Nanjing Medical University,Nanjing 210019,China)

机构地区：[1]南京医科大学附属儿童医院胸心外科,南京210019

出　　处：《中华小儿外科杂志》2024年第8期697-703,共7页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨婴幼儿体外循环(cardiopulmonary bypass,CPB)术中不同胶体渗透压(colloid osmotic pressure,COP)水平对患儿术后恢复的的影响。方法收集2019年12月至2020年7月在南京医科大学附属儿童医院首次行CPB下先天性心脏病矫治手术的67例患儿的临床资料,其中男29例,女38例,体重<8 kg。根据术中COP值分为低COP组(34例)和高COP组(33例)。统计术后凝血功能、肝肾功能、术后液体量、延迟关胸率、机械通气时间、ICU时间、住院时间等指标,判断术中维持不同COP水平对患儿术后恢复的影响。结果两组患儿CPB前COP值差异没有统计学意义(P>0.05),转机后10 min COP值均降到最低,随后均缓慢上升。CPB开始10 min、注射心肌保护液后及停机时COP值差异均有统计学意义(P<0.05)。两组患儿术后24 h白蛋白使用量低COP组小于高COP组[(3.18±4.29)g比(6.47±6.09)g,P<0.05];术后72 h乳酸值低COP组高于高COP组[(2.25±3.19)mmol/L比(1.16±0.66)mmol/L,P=0.05];术后24 h低COP组所需液体量多于高COP组[(558.18±220.23)mL比(442.00±156.25)mL,P<0.05];术后24 h低COP组更好的液体平衡量不如高COP组[(-73.36±170.26)mL比(-26.43±298.12)mL,P<0.05]。两组患儿住院时间、机械通气时间及ICU时间、二次手术率、延迟关胸率、呼吸机使用时间大于7 d率、腹膜透析率、肾替代治疗率,差异均无统计学意义(P>0.05)。低COP组术后24 h肌酐值小于高COP组[(30.64±8.98)μmmol/L比(40.54±25.24)μmol/L,P<0.05],低COP组术后72 h肌酐值小于高COP组[(26.14±8.95)μmmol/L比(39.85±27.52)μmmol/L,P<0.05]。结论较高的胶体渗透压水平有利于维持较好的液体平衡量,减少术后液体输入量,降低术后血乳酸水平及机械通气时间,对患儿肝功能、凝血功能损伤小。Objective To explore the effects of different levels of colloid osmotic pressure(COP)on postoperative recovery of infants during cardiopulmonary bypass(CPB).Methods From December 2019 to July 2020,the relevant clinical data were retrospectively reviewed for 67 children with congenital heart diseases(CHD)undergoing initial corrective surgery under CPB.There were 29 boys and 38 girls with body weight<8 kg.They were assigned into two groups of low COP(n=34)and high COP(n=33).Postoperative coagulation function,hepatorenal function,postoperative fluid volume,delayed chest closure rate,mechanical ventilation time,intensive care unit(ICU)duration and hospitalization stay were recorded.Results No significant inter-group difference existed in COP value at pre-CPB(P>0.05)and COP values dropped to the lowest at 10 min after transition and then rose slowly.Significant differences existed in COP at 10 min after CPB,myocardial protective fluid injection and stop time(P<0.05).At 24 h,amount of albumin used was lower in low COP group than that in high COP group[(3.18±4.29)vs(6.47±6.09)g,P<0.05].Lactate value of low COP group was higher than that of high COP group at 72 h postoperatively[(2.25±3.19)vs(1.16±0.66)mmol/L,P=0.05].At 24h,fluid requirement was higher in low COP group than that in high COP group[(558.18±220.23)vs(442.00±156.25)mL,P<0.05].At 24h,fluid balance of low COP group was better than that of high COP group[(-73.36±170.26)vs(-26.43±298.12)mL,P<0.05].No significant differences existed in hospitalization stay,mechanical ventilation time,ICU duration,rate of re-operation,rate of delayed chest closure,rate of ventilator use>7 days,rate of peritoneal dialysis or rate of renal replacement therapy(P>0.05).At 24h,creatinine value of low COP group was lower than that of high COP group[(30.64±8.98)vs(40.54±25.24)μmol/L].At 72h,creatinine value was lower in low COP group than that in high COP group[(26.14±8.95)vs(39.85±27.52)μmmol/L,P<0.05].Conclusion Higher colloid osmotic pressure level is beneficial for main

关 键 词：体外循环 胶体渗透压 婴儿 

分 类 号：R726.5[医药卫生—儿科]