改良超滤体外循环对婴幼儿心内直视手术术后心肺功能的影响(1)
[摘要] 目的:探讨改良超滤(MUF)对婴幼儿心内直视手术术后心肺功能的影响。方法:将40例行体外循环(CPB)下心内直视手术的婴幼儿随机分为MUF组(n=20)和无超滤对照组(简称对照组,n=20),动态观察CPB前、CPB停机以及MUF结束时(对照组在CPB停机20 min时)的血氧分压(PO2)及二氧化碳分压(PCO2)、术后呼吸机辅助呼吸时间、正性肌力药用量以及使用时间、左心室射血分数(LVEF)等心肺功能指标。结果:40例患儿无一例死亡。两组的PO2在CPB停机时与CPB停机前相比均明显下降,但MUF组在MUF结束时明显回升,接近CPB前水平,而对照组仅轻度回升,但仍明显低于CPB前;CPB停机20 min时MUF组PO2高于对照组。CPB停机后两组PCO2轻度升高,MUF后PCO2轻度下降,但组内、组间比较差异无统计学意义。术后MUF组呼吸机辅助时间、正性肌力药用量以及使用时间明显低于对照组。术后1周心脏超声心动图检查提示两组LVEF均较术前明显提高,但组间比较差异无统计学意义。结论:MUF有利于改善婴幼儿心内直视手术术后早期的心、肺功能。
, 百拇医药
[关键词] 改良超滤; 体外循环; 心功能; 肺功能; 婴幼儿
[中图分类号] R654.2[文献标识码] A[文章编号] 1671-7562(2010)01-0044-04
doi:10.3969/j.issn.1671-7562.2010.01.012
Influence of modified ultrafiltration on infants cardiopulmonary
function after open heart surgery
WANG Zhe-yan, LUO Xuan, YAO Hao, LIU Chang, CHEN Bao-jun,
, 百拇医药
CAO Bin, WANG Dong-jin
(Department of Cardiovascular Surgery, Nanjing Drum Tower Hospital, Medical College of Nanjing University, Nanjing 210008, China)
[Abstract] Objective: To investigate the influence of modified ultrafiltration(MUF) on infants cardiopulmonary function after open heart surgery with cardiopulmonary bypass(CPB). Methods: 40 infants with congenital heart diseases were randomly divided into the MUF group(n=20) and the control group(n=20). Arterial blood was measured to investigate PO2 and PCO2 before CPB at the end of CPB, at the end of MUF(or 20 minutes after CPB in control group). Besides, the doses of dopamine and LVEF before and after surgery were also measured. Results: No infants were dead in our research. Compared with the levels of PO2 before CPB, the levels of PO2 of the 2 groups were decreased significantly at the end of CPB. The level of PO2 in MUF group was increased significantly at the end of MUF, and it was close to the level before CPB, while the level of PO2 in control group was increased lightly at the end of MUF, and it was lower significantly than the level before CPB. Compared with the level of PO2 in control group, the level of PO2 in MUF group was increased significantly at 20 min after CPB. The levels of PCO2 of the 2 groups were increased lightly after CPB, and its levels were decreased lightly after MUF,but the differences between the 2 groups were not significant. Compared with the control group, the time of using life-support machine, the time of using cardiotonic drug,and the dosage of cardiotonic drug were lower significantly in MUF group. The LVEF of the 2 groups were improved significantly than before surgery at 1 week after surgery, but the difference between the 2 groups was not significant. Conclusion: Modified ultrafiltration can improve cardiopulmonary function of infants after open heart surgery.
, 百拇医药
[Key words] modified ultrafiltration; cardiopulmonary bypass; cardiac function; pulmonary function; infants
在婴幼儿体外循环(CPB)过程中,由于低温、低体重、血液稀释、炎症介质释放等原因造成毛细血管通透性增加,导致CPB后婴幼儿体内水分的大量潴留,由此造成的组织水肿及脏器功能不全尤其严重[1]。改良超滤(moditied ultrofiltration,MUF)可以在不增加CPB时间的前提下,迅速排除体内过多的液体,提高红细胞压积(HCT),同时去除循环血中部分炎症因子,减少术后出血量和ICU停留时间[2-3]。我科2008年1月~2009年3月在对20例15 kg以下婴幼儿行CPB下心内直视手术时施行MUF,取得了较好的效果。现就MUF对婴幼儿心内直视手术术后早期的心、肺功能影响进行探讨。, 百拇医药
, 百拇医药
[关键词] 改良超滤; 体外循环; 心功能; 肺功能; 婴幼儿
[中图分类号] R654.2[文献标识码] A[文章编号] 1671-7562(2010)01-0044-04
doi:10.3969/j.issn.1671-7562.2010.01.012
Influence of modified ultrafiltration on infants cardiopulmonary
function after open heart surgery
WANG Zhe-yan, LUO Xuan, YAO Hao, LIU Chang, CHEN Bao-jun,
, 百拇医药
CAO Bin, WANG Dong-jin
(Department of Cardiovascular Surgery, Nanjing Drum Tower Hospital, Medical College of Nanjing University, Nanjing 210008, China)
[Abstract] Objective: To investigate the influence of modified ultrafiltration(MUF) on infants cardiopulmonary function after open heart surgery with cardiopulmonary bypass(CPB). Methods: 40 infants with congenital heart diseases were randomly divided into the MUF group(n=20) and the control group(n=20). Arterial blood was measured to investigate PO2 and PCO2 before CPB at the end of CPB, at the end of MUF(or 20 minutes after CPB in control group). Besides, the doses of dopamine and LVEF before and after surgery were also measured. Results: No infants were dead in our research. Compared with the levels of PO2 before CPB, the levels of PO2 of the 2 groups were decreased significantly at the end of CPB. The level of PO2 in MUF group was increased significantly at the end of MUF, and it was close to the level before CPB, while the level of PO2 in control group was increased lightly at the end of MUF, and it was lower significantly than the level before CPB. Compared with the level of PO2 in control group, the level of PO2 in MUF group was increased significantly at 20 min after CPB. The levels of PCO2 of the 2 groups were increased lightly after CPB, and its levels were decreased lightly after MUF,but the differences between the 2 groups were not significant. Compared with the control group, the time of using life-support machine, the time of using cardiotonic drug,and the dosage of cardiotonic drug were lower significantly in MUF group. The LVEF of the 2 groups were improved significantly than before surgery at 1 week after surgery, but the difference between the 2 groups was not significant. Conclusion: Modified ultrafiltration can improve cardiopulmonary function of infants after open heart surgery.
, 百拇医药
[Key words] modified ultrafiltration; cardiopulmonary bypass; cardiac function; pulmonary function; infants
在婴幼儿体外循环(CPB)过程中,由于低温、低体重、血液稀释、炎症介质释放等原因造成毛细血管通透性增加,导致CPB后婴幼儿体内水分的大量潴留,由此造成的组织水肿及脏器功能不全尤其严重[1]。改良超滤(moditied ultrofiltration,MUF)可以在不增加CPB时间的前提下,迅速排除体内过多的液体,提高红细胞压积(HCT),同时去除循环血中部分炎症因子,减少术后出血量和ICU停留时间[2-3]。我科2008年1月~2009年3月在对20例15 kg以下婴幼儿行CPB下心内直视手术时施行MUF,取得了较好的效果。现就MUF对婴幼儿心内直视手术术后早期的心、肺功能影响进行探讨。, 百拇医药