改良超滤在体外循环重症瓣膜置换手术中的临床应用

目的评价改良超滤在重症心脏瓣膜病患者瓣膜置换术中的临床效果。方法选取拟行瓣膜置换术的重症心脏瓣膜病患者84例,随机分为常规超滤组(CUF组)43例和改良超滤组(MUF组)41例。分别在围术期的不同时间点采集动脉血样监测电解质和血气;监测心排量(CO)、心排指数(CI)、左室每搏做功指数(LVSWI)及平均动脉压(MAP);计算氧合指数并记录相应时间点的气道压。结果 2组患者超滤后CO、CI、LVSWI均显著提高;与CUF组比较,MUF组改善更为明显;术后8～24 h,MUF组氧合指数好于CUF组;MUF组术后24 h尿量、胸腔引流量、呼吸机支持时少于CUF组,2组间气道压和ICU停留时间无显著差异。结论改良超滤用于重症心脏瓣膜病瓣膜置换术患者,可改善术后心肺功能,且效果优于常规超滤。

Clinical application of modified ultrafiltration during CPB in adult patients with severe valve disease undergoing valve replacement procedure

Objective To evaluate the effect of modified ultrafiltration(MUF) in adult patients with severe valve disease undergoing valve replacement procedure.Methods Eighty-four patients were randomized into control group(CUF,n=43) and MUF group(MUF,n=41).Arterial blood gas,electrolyte,cardiac output(CO),cardiac index(CI),left ventricular-stroke work index(LVSWI),airway pressure(AP) and main arterial pressure(MAP) were measured at different time points during perioperative period.Results The haemodynamic parameter(CO,CI,LVSWI) improved in all patients and were significantly higher than that in CUF group after CPB.The oxygen index in MUF group was better than that in CUF group 8-24 hours after cpb.The intubation time, chest drainage and amounts of urine during cpb and the first 24 h after operation in MUF group were less than those in CUF group.There was no difference in ICU time and CO between two groups.Conclusion MUF is an effective technique to accelerate recovery of cardio-pulmonary function during perioperative period in adult patients with severe valve disease undergoing valve replacement procedure and better than CUF.