不同超滤法在小儿体外循环中的应用比较

目的 比较不同超滤法在小儿体外循环中的效果。方法 80例先天性心脏病病儿，随机分成4组，分别为对照（CUF）组，平衡超滤（BUF）组，改良超滤（MUF）组和平衡超滤＋改良超滤（B＋M）组。在围术期检测肿瘤坏死因子（TNF）、白细胞介素－8（IL－8）和E-selectin的浓度。结果 CUF组各类炎症因子的浓度随转流时间的延长不断上升，BUF和B＋M组停转流时炎症因子的浓度明显低于对照组和MUF组（P＜0．05）。MUF组进行超滤时，炎症因子浓度上升，红细胞压积不断升高，B＋M组在停体外循环时炎症介质浓度较低，但在改良超滤时上升，上升幅度较MUF组低。结论 平衡超滤法能降低体内炎症介质，改良超滤法可以在术后迅速浓缩血液，但不能降低炎症介质的浓度。平衡超滤和改良超滤结合起来应用，可兼有二者的作用，但仍不能在转流后将炎症介质的浓度保持在相当低的水平。

Balanced ultrafiltration, modified ultrafiltration and balanced ultrafiltration with modified ultrafiltration in pediatric cardiopulmonary bypass

Objective: To evaluate the effect of balance ultrafiltration, modified ultrafiltration and combination of balance ultrafiltration and modified ultrafiltration on inflammatory mediators in children's open heart surgery. Methods: 80 children with congenital heart disease were randomly divided into 4 groups, control group (CUF group), balanced ultrafiltration group (BUF group), modified ultrafiltration group (MUF group) and balanced ultrafiltration with modified ultrafiltration group (B+M group). Clinical data of these groups were similar. TNF,IL 8 and E selectin were measured at the beginning of CPB, 30 minutes later, the termination of CPB, the cessation of MUF (MUF group and B+M group) and 2 hours postoperatively. Results: During CPB, the concentrations of TNF, IL 8 and E selectin increased significantly in CUF group and MUF group and didn't change significantly in BUF group and B+M group. In the period of MUF, TNF and IL 8 increased whereas E selectin didn't change and at the same time, hematocrit increased. Conclusion: The study shows that ultrafiltration can filter out the inflammatory mediators, but only BUF can decrease the concentrations of them. And MUF only can concentrate blood. Combining both techniques has both effects, but the effect of BUF was offset by MUF.