零平衡超滤和静脉-动脉改良超滤在婴幼儿体外循环中的联合应用

目的 探讨零平衡超滤（ZBUF）和静脉-动脉改良超滤（V-A MUF）联合应用于婴幼儿体外循环（CPB）手术中的临床效果,判定二者联合应用的可行性及临床意义.方法 69例婴幼儿复杂先心病患者,其中男32例,女37例,年龄4～24个月,体重5～13 kg;选用MEDOS ME HFOS 0025婴儿型超滤器,CPB期间行ZBUF,CPB结束后采用静脉-动脉路径行改良超滤.观察患者平均动脉压（MAP）、血浆白细胞介素-6 （IL-6）、白细胞介素-8 （IL-8）、肿瘤坏死因子α（TNF-α）和血浆胶体渗透压（COP）、红细胞压积（HCT）变化.结果 所有患者MAP在V-A MUF结束时明显较CPB期间升高（P＜0.05）;V-A MUF结束时TNF-α、IL-6、IL-8与ZBUF过程中比较无明显差异（P＞0.05）;COP和HCT在V-A MUF结束时较CPB期间明显升高（P＜0.05）.结论 ZBUF与V-A MUF联合应用于婴幼儿CPB手术中可排除炎性因子,快速减少体内水分、提高COP和红细胞压积,从而改善心肺功能。

Combined Application of Zero-balanced Ultrafiltration and Venous-arterial Modified Ultrafiltration in Infants during Cardiopulmonary Bypass

Objective This study was aimed to investigate the clinical effects of combined application of zero-balanced ultrafiltration（ZBUF） and venous-arterial modified ultrafiltration（V-A MUF） in severe infant open heart surgery with cardiopulmonary bypass（CPB）,in order to evaluate the feasibility and clinical significance of combination of ZBUF and V-A MUF. Methods 69 pediatric patients diagnosed as complicated congenital heart disease had been involved,which included 32 males and 37 females with 4-24 months of age and 5-13 kg of weight.Gambro MEDOS ME HFOS 0025 hemofilter was selected in all patients. ZBUF was done during CPB and V-A MUF was performed after CPB. The changes of mean arterial pressure（MAP）,TNF-α,IL-6,IL-8,hematocrit（HCT）,and the plasma colloid osmotic pressure（COP） were measured at several time points. Results MAP,COP and HCT were significant higher after the end of V-A MUF（P〈 0.05） than during CPB in all patients.TNF-α,IL-6 and IL-8 had no significant differences during ZBUF and at the end of V-A MUF（P〉0.05）.Conclusion Combined application of ZBUF and V-A MUF can eliminate the inflammatory mediators and improve the respiratory and heart functions through decreasing the body water and increasing COP and HCT.