CAJ | 학술논문

背景:进口人工肾价钱昂贵,且存在设计方面的不足,如在滤除水分的同时也丢失了各种中小分子如电解质及葡萄糖等.目的:探讨国产人工肾聚砜膜透析器应用于心脏体外循环手术的可能性.方法:选择的17例患者中瓣膜置换术9例,冠脉搭桥5例,法乐氏四联症2例,右窒双出口1例.于常规的体外循环受过程中,在体外循环动脉端安装微栓过滤器,其顶端三通出口分虽连接泵压表、聚砜膜诱析器入血口和经硅胶管接贮血瓶与氧合器相连,通过调节动脉泵的流量确保动脉压和中心静脉压.以常规体外循环中使用过滤器联合利尿合剂治疗18例为对照.体外循环前后按常规计算预冲液量,并与麻醉师共同维持患者体外循环前后平均动脉压、中心静脉压的稳定.观察体外循环前后患者电解质、葡萄糖及渗透压的变化.结果与结论:聚砜膜透析器在体外循环手术中滤水作用十分明显,效果明显优于对照组,肾透析液中的电解质、尿素氮、葡萄糖和渗透压与使用人工肾前血液中的值无显著差别.提示国产聚砜膜透析器能够代替超滤器应用于体外循环手术中,且效果更理想,为术后心功能恢复和防止其他并发症的发生有良好作用,为一些重症心功能不全、转流时间长、婴幼儿、液体进入体内多而排出尿少等患者提供了另一条出路.
배경:진구인공신개전앙귀,차존재설계방면적불족,여재려제수분적동시야주실료각충중소분자여전해질급포도당등.목적:탐토국산인공신취풍막투석기응용우심장체외순배수술적가능성.방법:선택적17례환자중판막치환술9례,관맥탑교5례,법악씨사련증2례,우질쌍출구1례.우상규적체외순배수과정중,재체외순배동맥단안장미전과려기,기정단삼통출구분수련접빙압표、취풍막유석기입혈구화경규효관접저혈병여양합기상련,통과조절동맥빙적류량학보동맥압화중심정맥압.이상규체외순배중사용과려기연합이뇨합제치료18례위대조.체외순배전후안상규계산예충액량,병여마취사공동유지환자체외순배전후평균동맥압、중심정맥압적은정.관찰체외순배전후환자전해질、포도당급삼투압적변화.결과여결론:취풍막투석기재체외순배수술중려수작용십분명현,효과명현우우대조조,신투석액중적전해질、뇨소담、포도당화삼투압여사용인공신전혈액중적치무현저차별.제시국산취풍막투석기능구대체초려기응용우체외순배수술중,차효과경이상,위술후심공능회복화방지기타병발증적발생유량호작용,위일사중증심공능불전、전류시간장、영유인、액체진입체내다이배출뇨소등환자제공료령일조출로.
BACKGROUND: The imported artificial kidney costs much and has design deficiency, for example, various kinds of middle or small-sized molecules, such as electrolytes and glucose, are missing while filtering the water out.OBJECTIVE: To investigate the possibility of domestically produced artificial kidney for extracorporeal circulation during cardiac surgery.METHODS: A total of 17 patients were included, comprising 9 patients subjected to valve replacement, 5 undergoing coronary artery bypass, 2 suffering from fallot's tetralogy, and 1 with double outlet right ventricle. The arterial end of the extracorporeal circulation was provided with a microthrombus filter, with a T joint on its top with one of the ports connected with a pressure gauge,one connected with the blood inlet of the hemodialyzer, and one (the blood outlet) connected with the inlet of a blood container,which led the blood into an oxygenator. The arterial pressure and central venous pressure were maintained by regulating the flow rate of pressure gauge. Eighteen patients who received treatment using filter in conjunction with diuretic agent served as controls.Prior to and after extracorporeal circulation, cardioplegic solution was calculated, and the mean arterial pressure and central venous pressure were maintained. In addition, changes in electrolytes, glucose, and osmotic concentration were also monitored prior to and after extracorporeal circulation.RESULTS AND CONCLUSION: During cardiac surgery with extracorporeal circulation, polysulfone dialyser showed a significant water filtration. No significant difference was observed between prior to and after use of artificial kidney in terms of electrolyte,urea nitrogen, glucose, and osmotic pressure. These findings indicate that domestically produced artificial kidney polysulfone dialyser can substitute hyperfiltration apparatus to be applied to extracorporeal circulation with more benefits, which positively affect postoperative recovery of cardiac function, prevent from other complications, and provide another prospect for some patients with sever cardiac dysfunction or prolonged extracorporeal circulation, infant patients, or patients with higher liquid intake but lower urine volume.