改良超滤对婴儿体外循环心脏直视手术肺保护作用的研究

目的 探讨改良超痣对婴幼儿体外循环心脏直视手术肺保护的作用.方法 随机抽取2004年5月至2009年2月我院310例(年龄≤1岁,体重≤10 kg)行体外循环心脏直视手术患儿,分为改良超滤组(260例)和对照组(常规并行超滤50例),比较2组体外循环结束时、超滤开始时(或体外循环结束5 min)、超滤结束时(或体外循环结束20 min)和术后1、6 h气道峰压(Ppeak)、气道平台压(Pplate)及肺顺应性(CL)、氧合指数、肺水含量(TAF),比较2组术后呼吸机辅助通气时间.结果 改良超滤组Ppeak、Pplate及TAF在改良超滤后较对照组各时点明显下降(P<0.05),CL及氧合指数则明显增高(P<0.05);改良超滤组在超滤结束时(或体外循环结束20 min)、术后1、6 h各时点Ppeak、Pplate及TAF较对照组明显下降(P均<0.05);CL及氧合指数较对照组明显升高(P均<0.05);改良超滤组呼吸机辅助通气时间(5.9±2.3)h较对照组(9.3±2.0)h明显缩短(P<0.05).结论 改良超滤可明显改善体外循环后呼吸功能,是良好的耍幼儿体外循环心脏直视手术肺保护方法之一.

Protection of pulmonary function after modified ultrafiltration in infants undergoing opening heart operation by cardiopulmonary bypass

Objective To study the protection of pulmonary function after modified ultrafiltration(MUF) in infants undergoing opening heart operation by cardiopulmonary bypss (CPB).Methods 310 infants (age≤1 year,weight≤10 kg) by CPB were randomly divided into groups of receiving MUF group during CPB(n=260) and not receiving MUF during CPB group(n=50,control group).Ppeak、Pplate、CL、Oxygenation Index and TAF were compared between MUF and control group at the beginning of bypass and MUF,at the end of MUF and in 1,6 h after CPB.The time of mechanical ventilation were compared between the two groups.Results Ppeak、Pplate and TAF in MUF group significantly decreased after MUF(P<0.05),CL and Oxygenation Index increased(P<0.05).Ppeak,Pplate,CL,Oxygenation Index and TAF in MUF group at the three time after MUF(or 20 min after CPB) decreased compared to that in the control group(P<0.05),CL and Oxygenation Index increased(P<0.05).The duration of mechanical ventilation follow operation in MUF group was shorter than in the control group (P<0.05).Condusions MUF can improve pulmonary function.It is a good way for pulmonary protection in infants of opening heart operation by CPB.