CAJ | 학술논문

目的：运用近红外光谱仪（NIRS）监测超滤期间脑组织血氧参数的变化，比较不同改良超滤（MUF）方式的效率，提高婴幼儿改良超滤质量。方法20例简单先天性心脏病患儿随机分为两组，对照组采用传统改良超滤方式（ tMUF），实验组采用优化改良超滤方式（ mMUF）。在体外循环术后行MUF 8～12 min。 MUF期间，用近红外光谱仪（ NIRS）实时、连续监测两组患儿脑组织氧合指数（ TOI）、脑组织血红蛋白浓度指数（ THI）、氧合血红蛋白变化量（△O2 Hb）、以及有创动脉血压、中心静脉压（CVP）和血细胞比容（Hct）等指标。结果两种MUF方式都能显著提高脑血氧参数，较开始MUF时的各项参数变化具有统计学差异。 THI与脑组织的血红蛋白总浓度成正比，超滤期间，mMUF 组THI变化幅度为（0．91±0．60）mM/cm，tMUF 组为（0．46±0．30）mM/cm，mMUF组THI上升速度显著快于tMUF组（ P ＝0．033）。 mMUF组△O2Hb提高（7．42±2．94）mM，且避免了tMUF组在超滤初期的低效超滤时间。两组TOI呈缓慢上升趋势。 mMUF组红细胞比容（ Hct）上升更显著，MUF结束，Hct达到（0．369±0．018）（ P ＝0．001），无需再输血。 MUF期间，患儿血流动力学趋于稳定。结论使用优化改良超滤方式，能显著提高婴幼儿体外循环术后改良超滤的效率和质量，并能够改善脑组织血氧参数，稳定术后血流动力学，达到节约用血的目的。
목적：운용근홍외광보의（NIRS）감측초려기간뇌조직혈양삼수적변화，비교불동개량초려（MUF）방식적효솔，제고영유인개량초려질량。방법20례간단선천성심장병환인수궤분위량조，대조조채용전통개량초려방식（ tMUF），실험조채용우화개량초려방식（ mMUF）。재체외순배술후행MUF 8～12 min。 MUF기간，용근홍외광보의（ NIRS）실시、련속감측량조환인뇌조직양합지수（ TOI）、뇌조직혈홍단백농도지수（ THI）、양합혈홍단백변화량（△O2 Hb）、이급유창동맥혈압、중심정맥압（CVP）화혈세포비용（Hct）등지표。결과량충MUF방식도능현저제고뇌혈양삼수，교개시MUF시적각항삼수변화구유통계학차이。 THI여뇌조직적혈홍단백총농도성정비，초려기간，mMUF 조THI변화폭도위（0．91±0．60）mM/cm，tMUF 조위（0．46±0．30）mM/cm，mMUF조THI상승속도현저쾌우tMUF조（ P ＝0．033）。 mMUF조△O2Hb제고（7．42±2．94）mM，차피면료tMUF조재초려초기적저효초려시간。량조TOI정완만상승추세。 mMUF조홍세포비용（ Hct）상승경현저，MUF결속，Hct체도（0．369±0．018）（ P ＝0．001），무수재수혈。 MUF기간，환인혈류동역학추우은정。결론사용우화개량초려방식，능현저제고영유인체외순배술후개량초려적효솔화질량，병능구개선뇌조직혈양삼수，은정술후혈류동역학，체도절약용혈적목적。
Objective To compare the efficiency of different modified ultrafiltration ( MUF) methods and to improve the quali-ty of MUF in infants, we surveyed the cerebral oxygenation parameters by near infrared spectroscopy ( NIRS) during MUF period. Methods Twenty simple congenital heart disease patients were randomly assigned to one of the following groups:the traditional MUF ( tMUF) group ( contrast group, 10 cases) and the modified MUF ( mMUF) group ( experimental group, 10 cases) . The duration of MUF was 8 to 12 minutes. During MUF period, tissue oxygenation index ( TOI) , tissue hemoglobin concentration index ( THI) , and quantitative changes in cerebral concentration of oxygenated hemoglobin (△O2 Hb ) were detected by near infrared spectroscopy (NIRS) in real time. Arterial blood pressure (ABP), central venous pressure (CVP), and haematocrit (Hct) were also recorded.Re-sults The cerebral oxygenation parameters after MUF period were improved statistically significantly in both two groups. THI was pro-portional to the cerebral total hemoglobin concentration during MUF period. The average rangeability of THI in tMUF group and mMUF group was (0.46±0.30) mM/cm and (0.91±0.60) mM/cm respectively, and the ascending velocity of THI in mMUF group was faster than that in the tMUF group ( P=0.033). The△O2Hb in mMUF group was improved by (7.42±2.94) mM, and no period of low effi-cient MUF was observed in mMUF group. TOI was slowly rising in two groups. At the end point of MUF, the Hct of mMUF group, which reached to (36.86±1.79)% without extra blood transfusion, was statistically higher than that of tMUF group. The hemodynamic statuses of both group patients were tended to be stable. Conclusion Modified MUF could significantly enhance the efficiency and the quality of modified ultrafiltration after cardiopulmonary bypass in infants. The cerebral oxygenation parameters and the postoperative he-modynamic status were improved. The purpose of blood save was also achieved.