两种超滤技术对婴幼儿心脏手术后肺功能影响的对比研究

目的对比研究体外循环(CPB)中的常规超滤方法和改良超滤方法对婴幼儿心脏手术后肺功能的影响。方法随机选择30例7kg以下行心脏手术的婴幼儿患者,根据手术中应用常规超滤方法或改良超滤方法的不同,分成常规超滤组(CUF组,n=15)和改良超滤组(MUF组,n=15)。分别记录两组患儿术中超滤液量、库血预充量、超滤前后血细胞比容、术后监测呼吸功能(氧合指数、肺泡-动脉氧分压差、气道峰压)、呼吸机辅助通气时间和ICU监护时间。结果MUF组库血用量显著低于CUF组(P<0.01),且滤出水量明显多于CUF组(P<0.01);两组间超滤前后血细胞比容无明显差异;MUF组呼吸机辅助通气时间(27.1±2.6)h和ICU监护时间(2.5±0.9)d,均短于CUF组呼吸机辅助通气时间(32.2±1.4)h和ICU监护时间(3.8±2.2)d(P<0.05)。两组术后气道峰压差异无显著性(P>0.05),而术后12和24h的肺泡-动脉血氧分压差MUF组显著低于CUF组(P<0.05),氧合指数MUF组显著高于CUF组(P<0.05)。结论改良性超滤方法可明显改善小体重患儿心脏手术后的肺功能。

Comparative study of pulmonary function after conventional ultrafiltration or modified ultrafiltration during cardiac surgery of infants

Objective To compare the effects of conventional ultrafiltration and modified ultrafiltration in protecting patients ' pulmonary function during cardiopulmonary bypass.Methods Thirty infants patients (less than7kg)were divided into two groups:conventional ultrafiltration group(CUF,n=15)and modified ultrafiltration group(MUF,n=15).The volume of ultrafiltration,transfusion,hematocrit(HCT)before and after ultrafiltration,patients ' respiration function (respiration index,A-aDO2,airway pressure),the time of mechanical ventilation and ICU in the two groups were respectively monitored.Results The transfusion in MUF group was significantly less than in CUF group(P<0.01),and the volume of ultrafiltration in MUF group was significantly more than in CUF group(P<0.01).The time of mechanical ventilation and ICU staying in MUF group were significantly shorter in MUF group than that in CUF group(P<0.05).At 12and24hours after operations,the A-aDO2in MUF group was lower than that in CUF group(P<0.05),and the respiratory index in MUF group was higher than that in CUF group(P<0.05).Conclusion The modified ultrafiltration can effectively improve pulmonary function after operations for low weight infants.