CAJ | 학술논문

目的：探讨改良超滤对成人心脏瓣膜置换术后肺功能的影响。方法选取60例拟行成人心脏瓣膜置换术的患者，随机分为两组，M组为改良超滤组（n=30），C组为无超滤对照组（n=30）。监测两组患者体外循环前、改良超滤前、改良超滤后的血细胞比容、氧合指数、肺泡-动脉氧分压差等各项指标。记录两组术后呼吸机辅助时间及术后重症监护室监护时间。结果M组超滤前的血细胞比容比体外循环前显著降低（P<0.05），超滤后血细胞比容比超滤前已有显著提高（P<0.05），但仍比体外循环前低（P<0.05）。M组术后呼吸机辅助时间及术后重症监护室监护时间均明显短于C组（P<0.05），M组超滤后氧合指数值明显高于C组（P<0.05），M组超滤后肺泡-动脉氧分压差值明显低于C组（P<0.05）。结论心脏瓣膜置换术患者体外循环过程中应用改良超滤，可以有效减轻术后组织水肿，降低炎症反应，促进术后早期肺功能的恢复。
목적：탐토개량초려대성인심장판막치환술후폐공능적영향。방법선취60례의행성인심장판막치환술적환자，수궤분위량조，M조위개량초려조（n=30），C조위무초려대조조（n=30）。감측량조환자체외순배전、개량초려전、개량초려후적혈세포비용、양합지수、폐포-동맥양분압차등각항지표。기록량조술후호흡궤보조시간급술후중증감호실감호시간。결과M조초려전적혈세포비용비체외순배전현저강저（P<0.05），초려후혈세포비용비초려전이유현저제고（P<0.05），단잉비체외순배전저（P<0.05）。M조술후호흡궤보조시간급술후중증감호실감호시간균명현단우C조（P<0.05），M조초려후양합지수치명현고우C조（P<0.05），M조초려후폐포-동맥양분압차치명현저우C조（P<0.05）。결론심장판막치환술환자체외순배과정중응용개량초려，가이유효감경술후조직수종，강저염증반응，촉진술후조기폐공능적회복。
Objective To investigate the effect of modified ultrafiltration (MUF) on lung functions of patients after cardiac valve replacement. Methods 60 patients who would undergo cardiac valve replacement were randomly divided into M (modiifed ultraifltration) group (n=30) and C (control) group (n=30). Parameters including haematocrit (HCT), oxygenation index (OI) and alveolar-arterial oxygen tension gradient (P(A-a)O2) of patients before cardiopulmonary bypass (CPB) were monitored, and those parameters of patients before and after modified ultrafiltration were also monitored. The mechanical ventilation time and ICU supervision time of patients after cardiac valve replacement in the two groups were also recorded. Results HCT of patients at pre-MUF was obvious lower than that at pre-CPB (P<0.05), and HCT of patients at post-MUF was obvious higher than that at pre-MUF (P<0.05) while was still lower than that at pre-CPB (P<0.05) in M group. The mechanical ventilation time and ICU supervision time of patients in M group were obvious shorter than that in C group (P<0.05). OI of patients at post-MUF in M group was obvious higher than that in C group (P<0.05). P(A-a)O2 of patients at post-MUF in M group was obvious lower than that in C group (P<0.05). Conclusion The application of modiifed ultraifltration in cardiopulmonary bypass in cardiac valve replacement can decrease postoperative edemata and inlfammation reactions, which is beneifcial to the recovery of pulmonary functions.