高原地区体外循环应用超滤对儿童术后右心室功能的影响  

Protective effects of ultrafiltration on right ventricular function in children after cardiopulmonary bypass at high altitude

作　　者：王志农[1] 王军[1,2] 李素芝[3] 王军[1,2] 张富军[1] 顾晖[1] 王洪亚[3] 张宝仁 

机构地区：[1]第二军医大学长海医院胸心外科,上海200433 [2]解放军沈阳军区总医院心脏外科 [3]解放军西藏军区总医院心胸外科

出　　处：《中华心血管病杂志》2003年第5期357-360,共4页Chinese Journal of Cardiology

摘　　要：目的　探讨高原地区体外循环 (CPB)中应用血液超滤技术对心内直视手术后右心室功能的保护作用。方法　选择在海拔 370 0m开展的CPB心脏手术患者 12例 ,根据CPB过程中有无应用血液超滤技术 ,将患者分成血液超滤组和对照组 ,分别于CPB前、CPB结束时以及CPB后 1h、3h、6h、12h、2 4h ,测定肺动脉平均压 (MPAP)、右心房压 (RAP)、右心室舒张末容积指数 (RVEDVI)、右心室射血分数 (RVEF)、心脏指数 (CI)、右心室每搏容量指数 (RVSI)和肺血管阻力指数 (PVRI)。结果　CPB结束和CPB后 6h内 ,对照组MPAP、RVEDVI以及RAP均较CPB前明显升高 (P <0 0 5 ) ,而RVEF、CI和RVSI较CPB前降低 (P <0 0 5 ) ;CPB后 12h对照组MPAP、RVEDVI以及RAP均逐渐减低 ,但RVEF、CI和RVSI仍未高于CPB前 ;血液超滤组RVEF、CI和RVSI在CPB后各时间点均显著高于对照组 (P <0 0 5 )。结论　高原地区在CPB下施行心内直视手术后早期 ,右心室心肌收缩力显著降低 ,右心室的泵血功能受损 ;CPB中应用血液超滤技术有利于CPB后心脏泵血功能的恢复。Objective To evaluate the influence of cardiopulmonary bypass (CPB) on postoperative right ventricular (RV) systolic function and to elucidate the protective effects of ultrafiltration on RV pump function after CPB in children at high altitude. Methods Twelve congenital heart defect (CHD) patients with pulmonary hypertension, who underwent operative repair under CPB in Lasa at an altitude of 3 700 meters, were prospectively randomized into ultrafiltration group (UF group) and control group according to whether or not to apply ultrafiltration technique during CPB. Mean pulmonary arterial pressure (MPAP), right atrial pressure (RAP), RV end diastolic volume index (RVEDVI), RV ejection fraction (RVEF), cardiac index (CI), RV stroke volume index (RVSI) and pulmonary vascular resistance index (PVRI) were measured or calculated respectively by thermodilution technique after the induction of anesthesia, at the end of CPB, and 1, 3, 6, 12, 24 hours after weaning CPB. Results When compared with those before CPB, RVEF, CI and RVSI in control group were significantly reduced at the end of CPB and during the period of 6 hours after CPB ( P <0.05) while RAP, RVEDVI and MPAP were markedly increased ( P <0.05). PVRI in control group was not reduced in the period of 12 hours after CPB as compared with that before CPB ( P >0.05). But in UF group, RVEF, CI and RVSI were well maintained despite lower right ventricular preload (RVEDVI and RAP) during the early postoperative period (6 hours after CPB) ( P <0.05) and thereafter RVEF, CI and RVSI were significantly elevated 12 hours after CPB ( P <0.05) when compared with those before CPB. Moreover, RVEF, CI and RVSI were significantly improved postoperatively in UF group when compared with those in control group ( P <0.05). Conclusion CPB at the high altitude could result in a transient reduction of RV systolic function. Utrafiltration produced a marked improvement in RV systolic function as well as RV pump function after CPB in CHD children, especially during the early postoperativ

关 键 词：高原地区 体外循环 超滤 儿童 术后 右心室功能 心内直视手术 

分 类 号：R726.5[医药卫生—儿科]