改良超滤在婴幼儿体外循环中的应用

Application of modified ultrafiltration in infants undergoing cardiac surgery with cardiopulmonary bypass

摘要:

目的：婴幼儿各组织器官发育尚未成熟，体外循环后各种并发症也相对较为严重。改良超滤技术被证明能减轻婴幼儿体外循环所带来的不利影响，该文分析改良超滤在幼儿体外循环手术中的应用情况。方法：分析261名1岁以下在体外循环下行心脏手术的患者，其中205例（超滤组）体外循环后行改良超滤，56例（对照组）不行改良超滤。比较两组患者的转流时间、主动脉阻断时间、术后引流量、术后输血量、术后呼吸机通气时间、术后24 h时的血球压积以及氧合指数等围手术期资料。结果：超滤组没有发生与超滤有关的并发症，两组患者转流时间和主动脉阻断时间无明显差异，超滤组患者术后引流量和输血量较对照组少，呼吸机通气时间较短，而术后血球压积以及氧合指数较对照组高。结论：改良超滤技术在幼儿体外循环心脏手术后可以明显减少出血量和输血量，可以提高肺的氧合功能，改善呼吸功能，缩短呼吸机支持时间，有利于患者术后恢复。

Abstract:

OBJECTIVE: Infants are usually subjected to serious complications after cardiac surgery with cardiopulmonary bypass (CPB). This study was conducted to evaluate the effects of a modified ultrafiltration technique (MUF) on infants undergoing cardiac surgery with CPB. METHODS: A total of 261 infants less than 1 year old with congenital heart disease and who required CPB were randomized into receive MUF during CPB (n=205) or not (n=56, control group). Bypass duration, aortic cross-clamp duration, postoperative blood effluents and transfusions, mechanical ventilation duration following operation, and hematocrit and oxygenation index 24 hrs postoperatively were compared between the two groups. RESULTS: No ultrafiltration-related complication was found in the MUF group. There were no significant differences in the duration of bypass and aortic crossclamp between the two groups. Postoperative blood effluents and transfusions in the MFU group were significantly reduced (79.5±18.6 mL vs 57.3±15.4 mL and 78.1±32.5 mL vs 67.9±25.6 mL respectively) compared with the control group (P<0.05). The duration of mechanical ventilation following operation in the MFU group was shorter than that in the control group (28.6 ± 9.1 hrs vs 32.3 ± 8.7 hrs; P<0.05). MUF produced a significant improvement in hematocrit (34.6 ± 3.7 min vs 29.8±2.8 min; P<0.01) and oxygenation index ( 275.2±39.1 vs 202.2±25.6; P<0.01) 24 hrs postoperatively when compared with the control group. CONCLUSIONS: MFU can reduce postoperative bleeding and blood transfusions, improve pulmonary function and shorten the duration of mechanical ventilation in infants undergoing cardiac surgery with CPB.