改良超滤在重症瓣膜病体外循环中的临床应用

目的总结重症心脏瓣膜病体外循环中使用改良超滤的临床经验，探讨提高早期生存率的措施。方法自2005年6月至2008年7月，对78例重症心脏瓣膜病行瓣膜置换术体外循环中加用改良超滤，其中单纯二尖瓣置换12例，二尖瓣置换十三尖瓣成形22例，单纯主动脉瓣置换8例，二尖瓣＋主动脉瓣置换＋三尖瓣成形35例，二尖瓣置换＋冠状动脉旁路移植术1例。复温开始超滤，在血液动力学基本稳定时，开始改良超滤，超滤时间和超滤量以红细胞压积来决定，根据患者的血容量、胶体渗透压、红细胞压积，选择超滤速度和滤出量。结果死亡6例，其中术后并发低心排血量5例，心室颤动治疗无效死亡1例，死亡率7．69％。随访53例，平均随访2．5年，死亡5例。结论改良超滤能高效超滤多余水分减少机体水肿和滤出炎症介质减少炎性反应，提高了左心室收缩功能及舒张顺应性，明显提高术后心指数、左室每搏功指数和每搏指数，减少术后早期尿量，缩短呼吸机辅助通气时间和重症监护时间，重症瓣膜病手术患者应用改良超滤会有效提高术后早期的预后。

Clinical application of modified ultrafiltration in cardiopulmonary bypass for patients with severe heart valular disease

Objective In order to observe the effect of modified uhrafihration in cardiopulmonary bypass for patients with severe heart valvlar disease. Methods From June 2005 and July 2007, 78 patients with severe valvular disease had been underwent modified ultrafiltration in cardiopulmonary bypass of valvular replacement were retrospective reviewed.In all of them, mitral valve replacement was performed in 12 cases; mitral valve replacement additional tricuspid armuloplasty was performed in 22 cases ; Aortic valve replacement was performed in 8 cases; both mitral and aortic valve replacement additional tricuspid annuloplasty was performed in 35 cases ; mitral valve replacement additional coronary artery bypass grafting was performed in one ease. Ultrafiltration were began at time of rewarming when hemodynamies were stable. The times and amounts of ultrafiltration were determined by patients＇ hematocrits, colloid osmotic pressure and blood volume. Results In all 78 cases, 72 cases cured, 3 cases failed post-operative early, in which 2 cases failed because pump failure, one case failed because ventricular fibrillation. Conclusion Modified ultrafihration can filter out the unnecessary water and concentrate the blood, and also the inflammatory mediators can be removed by ultrafihration, so alleviate the inflammatory response after operations with cardiopulmonary bypass. Modified ultrafiltration in cardiopulmonary bypass could significantly improve the survival rate of valve replacement for the patients with severe valvular heart disease.