超滤法对体外循环心脏手术价值的临床研究

体外循环下心内直视手术病人80例分为两组,超滤组采用三种血液滤器,超滤时间为63.5±26.0分钟,每次滤液1441.9±597.8毫升。超滤组液体平衡+448.4±277.0毫升,对照组为+1568.8±327.0毫升,呈高度显著性差异;Hct和Hb从超滤前的24.15vol％和69.2g/L显著地分别上升到32.15vol％和97.2g/L,且显著地大于对照组停机时相应的23.92vol％和75.0g/L。超滤后全血体积平均减少28.2％,血浆体积减少35.1％,细胞外液减少39.9％,组织间隙液减少4.8％;超滤能提高血浆蛋白浓度和胶体渗透压。上述变化率均明显超过对照组。滤液能排出K~+、Na~+、Cl~-、HCO_3~-、BUN、Cr和肝素,但超滤未严重干扰体内电解质平衡,酸硷平衡和凝血因素,未引起严重溶血。作者认为:超滤法是一种简单,安全和有效的体外循环新技术,可以作为心内直视手术中一种常规方法。

Clinical Evaluation of Ultrafiltration on Cardiac Surgery during Cardiopulmonary Bypass

Ultrafiltration (UF) with three hemofilters during open heart operations was evaluated in two groups of 80 patients. The ultrafiltration time was 63.5+26.0 minutes. The filtrate amounted to 1441.95+97.8 ml and brought the positive fluid balance down to +448.4+277.0 ml in contrast to +1568.8 +327.0 ml in the control group. This difference is highly significant. The meanpost-UF hematocrit 32.15vol% and hemoglobin 97.2g/L were higher than the pre-UF 24.15vol% and 69.2g/L, and also higher than the post-bypass 23.92vol％ and 75.0g/L in the control group. UF brought the percentage changes in volumes of blood, plasma,extracellular and interstitial fluid down to 28.2%, 35.1％, 39.9％, and 4.8％, respectively, and increased plasma proteins and colloidal oncotic pressure. These differences between the UF and control group are highly significant. UF could remove K~+, Na~+, Cl~-, HCO_3~- BUN, Cr and heparin, and brought no remarkable changes in electrolytes and acid-base balance, coagulation and hemolysis. The authors believe that UF is a relatively simple, safe and effective technique of hemoconcentration during cardiopulmonary bypass, and UF may be a clinical routine method in open heart operations.