平衡超滤联合改良超滤对婴幼儿体外循环术后肺功能的影响

目的研究平衡超滤联合改良超滤对婴幼儿体外循环术后肺功能的影响。方法60例先天性心脏病患儿分为对照组（C）、改良超滤组（M）和平衡超滤联合改良超滤组（U）。C组体外循环中不使用超滤，M组在转流结束后应用改良超滤，U组在转流开始后进行平衡超滤，转流结束后进行改良超滤。分别在转流前（T1），转流结束后20min（T2），术后2h（T3），术后6h（T4），术后12h（T5）测定记录气道峰压（Ppeak）、呼吸停顿压（Ppause）、潮气量（TV）、呼吸频率（F）、吸入氧浓度（Fi02）和吸气比例（insp％）、动脉血中自介素6（IL-6）和白介素8（IL-8）的浓度。结果各组体外循环术后较术前的肺静态顺应性（Cstat）、气道阻力（Raw）、肺泡-动脉氧分压（AaDCh）、氧合指数（OI）、IL-6及IL-8浓度都有明显变化。在T5时间U组的Cstat明显高于M组和C组，Raw明显低于M组和C组；在T4、T5时间U组的AaD02明显低于M组和C组，OI明显高于M组和C组；在T2、T3、T4、T5时间U组的IL-6和IL-8浓度明显低于M组和C组。结论体外循环手术中联合应用平衡超滤和改良超滤能改善患儿肺的通气功能和换气功能，并能降低血浆中的炎性因子的浓度，减轻炎性反应，保护肺功能。

The effect of balanced ultrafiltration in combination with the modified ultrafiltration on pulmonary function in pediatric open heart surgery

Objective To study the effect of balanced ultrafi|tration with modified ultrafiltration on pulmonary function in pediatric open heart surgery.Methods 60 cases with congenital heart disease were divided into control group (C),modified ultrafiltration group (M) and balanced ultrafiltration with modified ultrafiltration group(U).In the C group,the cardiopulmonary bypass (CPB) was used without ultrafiltration,while in the other two groups additional modified ultrafiltration and balanced ul- trafiltration with modified ultrafiltration was used separately.The pneumodynamic parameters and in- flammatory mediators were measured at specific time points.Results The static pulmonary compliance (Cstat),peak airway pressure(Raw),alveolar-arterial oxygen difference(AaDO_2),oxygen index (OI) and the level of IL-6 ,IL-8 were dramatically different after CPB in the three groups.The U group's Cstat was higher and the Raw was lower than the M group and C group.At T4,T5 time points,the AaDO_2 of U group was lower and OI was higher than those of M and C group.In the U group,the lev- el of IL-6 and IL-8 were lower compared to those of M group and C group at T2,T3,T4,T5 times. Conclusions Combined balanced ultrafiltration with modified ultrafiltration produces an immediate im- provement of pulmonary ventilation and air exchange.