两种不同超滤技术在二尖瓣置换术中影响输血量的研究

目的探讨完全型改良超滤技术在二尖瓣置换术中节约用血的临床应用价值。方法 60例接受二尖瓣置换术患者。随机分为A、B两组。A组为对照组,采用常规超滤;B组为实验组,采用常规超滤+完全型改良超滤技术回输全部剩余机血。监测两组患者术前、超滤前、超滤后红细胞比容(Hct)、血浆胶体渗透压(COP)、超滤液量、术后24 h胸腔引流量、用库血量和血浆量等指标。结果两组患者均无手术死亡或与体外循环(ECC)和超滤有关的并发症。术前Hct、COP无显著性差异;超滤后Hct、COP两组比较有显著性差异,实验组明显高于对照组(P0.05)。实验组超滤液量显著多于对照组(P0.05),而输入库血及血浆量、术后24 h胸腔引流量明显低于对照组(P0.05)。结论与常规超滤相比,应用常规超滤+完全型改良超滤技术回输全部剩余机血,可减少库血用量,达到节约用血之目的,并有利于患者血流动力学稳定。

A comparative study of two different ultrafiltration techniques on the impact of blood transfusion in mitral valve replacement surgery

Objective To investigate the clinical value of the modified ultrafiltration technology on blood conservation in mitral valve replacement surgery. Methods 60 patients who accepted mitral valve replacement operation were randomly divided into two groups： group A （control group） and group B （experimental group）. Conventional uhufihration technique was applied in group A, while in group B, both conventional ultufihration and modified ultraflhration technique to reinfusion all remaining machine blood was used. Indicators were detected such as hematocrit （Hct） and plasma colloid osmotic pressure （PCOP） before operation, before and af- ter ultrafiltration, also the ultrafiltrate volume, chest drainage volume in 24 hours after operation, usage volume of banked blood and plasma were recorded. Results All patients of both groups had no operative mortality or complication related to cardiopulmonary by- pass or ultrafiltration. There was no significant difference between group A and group B in Hct and PCOP before operation. There was a significant difference between group A and group B （ P 〈0.05） in postoperative Hct and PCOP. And the ultrafiltrate volume of experi- mental group was significantly more than that of the control group （ P 〈0.05 ）. Chest drainage volume in 24 hours after operation and usage volume of banked blood and plasma were significantly lower in experimental group than the control group （ P 〈0.05）. Conclu- sion Compared with conventional uhrafiltration, conventional uhrafihration joint the completely-type modified ultraaqltration technique can reinfusion all the remaining machine blood and reduce the amount of banked blood, therefore can achieve the purpose of blood con- servation and promote the patient＇s hemodynamic stability.