中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2012年
6期
661-664
,共4页
风湿性心脏病%心脏瓣膜假体植入%体外循环%超滤
風濕性心髒病%心髒瓣膜假體植入%體外循環%超濾
풍습성심장병%심장판막가체식입%체외순배%초려
Rheumatic heart disease%Heart valve prosthesis implantation%Cardiopulmonary bypass%Ultrafiltration
目的 评价改良超滤联合常规超滤用于重症心脏瓣膜病患者瓣膜置换术的效果.方法 择期行瓣膜置换术的重症心脏瓣膜病患者108例,性别不限,年龄≥18岁,体重50～80kg,采用随机数字表法,将患者随机分为常规超滤绀(CUF组,n=56)和改良超滤联合常规超滤组(CMUF组,n=52).CMUF组于 CPB结束后行改良超滤,流世400 ml/min,超滤时间15～20 min.分别于诱导后(T1)、常规超滤开始(T2)、常规超滤结束(T3)、改良超滤开始(T4)、改良超滤结束(T5)、CPB结束后2 h(T6)、8h(T7)及24 h(T8)时采集动脉血样行血气分析,并测定血浆IL-6和IL-8浓度.计算T5-8时的氧合指数,并记录气道压.记录术中尿量、术后24 h尿量、胸腔引流量、术后呼吸机支持时间、术后血制品使用情况及ICU停留时间.结果 与CUF组比较,CMUF组T5,6时Hct升高,T7,8时氧合指数升高,术后呼吸机支持时间、术后24 h尿量、胸腔引流量和浓缩红细胞用量减少(P＜0.05)、血浆IL-6和IL-8浓度、气道压、术中尿量和ICU停留时间比较差异无统计学意义(P＞0.05).结论 改良超滤联合常规超滤可于重症心脏瓣膜病瓣膜置换术患者,改善术后脏器功能,减少异体输血.
目的 評價改良超濾聯閤常規超濾用于重癥心髒瓣膜病患者瓣膜置換術的效果.方法 擇期行瓣膜置換術的重癥心髒瓣膜病患者108例,性彆不限,年齡≥18歲,體重50～80kg,採用隨機數字錶法,將患者隨機分為常規超濾紺(CUF組,n=56)和改良超濾聯閤常規超濾組(CMUF組,n=52).CMUF組于 CPB結束後行改良超濾,流世400 ml/min,超濾時間15～20 min.分彆于誘導後(T1)、常規超濾開始(T2)、常規超濾結束(T3)、改良超濾開始(T4)、改良超濾結束(T5)、CPB結束後2 h(T6)、8h(T7)及24 h(T8)時採集動脈血樣行血氣分析,併測定血漿IL-6和IL-8濃度.計算T5-8時的氧閤指數,併記錄氣道壓.記錄術中尿量、術後24 h尿量、胸腔引流量、術後呼吸機支持時間、術後血製品使用情況及ICU停留時間.結果 與CUF組比較,CMUF組T5,6時Hct升高,T7,8時氧閤指數升高,術後呼吸機支持時間、術後24 h尿量、胸腔引流量和濃縮紅細胞用量減少(P＜0.05)、血漿IL-6和IL-8濃度、氣道壓、術中尿量和ICU停留時間比較差異無統計學意義(P＞0.05).結論 改良超濾聯閤常規超濾可于重癥心髒瓣膜病瓣膜置換術患者,改善術後髒器功能,減少異體輸血.
목적 평개개량초려연합상규초려용우중증심장판막병환자판막치환술적효과.방법 택기행판막치환술적중증심장판막병환자108례,성별불한,년령≥18세,체중50～80kg,채용수궤수자표법,장환자수궤분위상규초려감(CUF조,n=56)화개량초려연합상규초려조(CMUF조,n=52).CMUF조우 CPB결속후행개량초려,류세400 ml/min,초려시간15～20 min.분별우유도후(T1)、상규초려개시(T2)、상규초려결속(T3)、개량초려개시(T4)、개량초려결속(T5)、CPB결속후2 h(T6)、8h(T7)급24 h(T8)시채집동맥혈양행혈기분석,병측정혈장IL-6화IL-8농도.계산T5-8시적양합지수,병기록기도압.기록술중뇨량、술후24 h뇨량、흉강인류량、술후호흡궤지지시간、술후혈제품사용정황급ICU정류시간.결과 여CUF조비교,CMUF조T5,6시Hct승고,T7,8시양합지수승고,술후호흡궤지지시간、술후24 h뇨량、흉강인류량화농축홍세포용량감소(P＜0.05)、혈장IL-6화IL-8농도、기도압、술중뇨량화ICU정류시간비교차이무통계학의의(P＞0.05).결론 개량초려연합상규초려가우중증심장판막병판막치환술환자,개선술후장기공능,감소이체수혈.
Objective To evaluate the efficacy of modified ultrafiltration (MUF) combined with conventional ultrafiltration (CUF) for cardiac valve replacement in patients with severe valve disease.Methods One hundred and eight NYHA Ⅲ or Ⅳ patients with severe valve disease,aged≥ 18 yr,weighing 50-80 kg,scheduled for elective cardiac valve replacement under cardiopulmonary bypass (CPB) were randomized into CUF group ( n =56) and CUF combined with MUF group (CMUF group,n =52).MUF was performed at the end of CPB,and the flow and time was 400 ml/min and 15-20 min respectively.Arterial blood samples were taken for blood gas analysis and for measurement of the plasma IL-6 and IL-8 concentrations after induction of anesthesia (T1),at the beginning of CUF (T2),at the end of GUF (T3),at the beginning of MUF (T4),at the end of MUF (T5),and at 2,8 and 24 h after the termination of CPB (T5-8).The oxygenation index was calculated and the airway pressure was recorded at T5 8.The amount of urine output during operation,the amount of urine output and volume of chest tube drainage within 24 h after operation,extubation time,packed red blood cell (PRBC) transfusion and duration of stay in ICU were recorded.Results Compared with CUF group,the hematocrit at T5,6 and oxygenation index at T7,8 were significantly increased,extuhation time was significantly shortened,and the amount of urine output and volume of chest tube drainage within 24 h after operation and PRBC transfusion were significantly reduced ( P ＜0.05),and no significant change was found in the plasma IL-6 and IL-8 concentrations,airway pressurc,amount of urine output during operation,and the duration of stay in ICU in group CMUF ( P ＞ 0.05).Conclusion Combination of MUF and CUF during CPB can be used for cardiac valve replacement in patients with severe valve disease,improve the function of organs after operation and reduce homologous blood transfusion.
