中国医药导刊
中國醫藥導刊
중국의약도간
CHINESE JOURNAL OF MEDICAL GUIDE
2012年
12期
2028-2029
,共2页
叶刚%牟俊英%吴述轩%刘川鄂%谭祖海
葉剛%牟俊英%吳述軒%劉川鄂%譚祖海
협강%모준영%오술헌%류천악%담조해
复合超滤%婴幼儿%体外循环术%先心病%肺功能
複閤超濾%嬰幼兒%體外循環術%先心病%肺功能
복합초려%영유인%체외순배술%선심병%폐공능
Composite ultrafiltration%Baby%Extracorporeal circulation technique%Congenital heart disease%Lung function
目的:探讨符合超滤对婴幼儿体外循环术后肺功能的影响.方法:选取我院2008年8月至2012年2月收治的300例复杂重症先天性心脏病患儿为研究对象,按照随机原则分为对照组、改良超滤组和复合超滤组,其中对照组在整个体外循环术过程中不使用超滤,改良超滤组在体外循环结束后采用改良超滤,复合超滤组在体外循环过程中应用平衡超滤,体外循环结束后开始运用改良超滤,比较三组患儿在转流前(T1)、转流结束后20min(T2)、术后2h(T3)、术后6h(T4)、术后12h(T5)及术后24h(T6)时的潮气量(TV)、呼吸停顿压(Ppause)、气道峰压值(Ppeak)、呼吸频率(F)、吸入氧浓度(FiO2)等肺功能指标的变化.并在测定以上6个时间点的白细胞介素6(IL-6)、肿瘤坏死因子(TNF-α)的含量.结果:三组患者术后的肺静态顺应性(Cstat)、氧合指数(OI)显著低于术前,肺泡一动脉氧分压(AaDO2)显著高于术前,P<0.05.复合超滤组在T4、T5的Cstat、OI显著高于对照组和改良超滤组,P<0.05,改良超滤组的要显著高于对照组,P<0.05.复合超滤组在T4、T5的AaD02显著低于对照组和改良超滤组,P<0.05,改良超滤组的要显著高于对照组,P<0.05.三组患儿术后的IL-6、TNF-α显著高于术前,P<0.05.复合超滤组在T2、T3、T4、T5的IL-6、TNF-α显著低于对照组和改良超滤组,P<0.05.结论:复合超滤能够改善患儿肺的通气功能和换气功能,有效减轻全身炎症反应,使患儿能在术后尽早脱机,减少CPB术后并发症,保护患儿肺功能.
目的:探討符閤超濾對嬰幼兒體外循環術後肺功能的影響.方法:選取我院2008年8月至2012年2月收治的300例複雜重癥先天性心髒病患兒為研究對象,按照隨機原則分為對照組、改良超濾組和複閤超濾組,其中對照組在整箇體外循環術過程中不使用超濾,改良超濾組在體外循環結束後採用改良超濾,複閤超濾組在體外循環過程中應用平衡超濾,體外循環結束後開始運用改良超濾,比較三組患兒在轉流前(T1)、轉流結束後20min(T2)、術後2h(T3)、術後6h(T4)、術後12h(T5)及術後24h(T6)時的潮氣量(TV)、呼吸停頓壓(Ppause)、氣道峰壓值(Ppeak)、呼吸頻率(F)、吸入氧濃度(FiO2)等肺功能指標的變化.併在測定以上6箇時間點的白細胞介素6(IL-6)、腫瘤壞死因子(TNF-α)的含量.結果:三組患者術後的肺靜態順應性(Cstat)、氧閤指數(OI)顯著低于術前,肺泡一動脈氧分壓(AaDO2)顯著高于術前,P<0.05.複閤超濾組在T4、T5的Cstat、OI顯著高于對照組和改良超濾組,P<0.05,改良超濾組的要顯著高于對照組,P<0.05.複閤超濾組在T4、T5的AaD02顯著低于對照組和改良超濾組,P<0.05,改良超濾組的要顯著高于對照組,P<0.05.三組患兒術後的IL-6、TNF-α顯著高于術前,P<0.05.複閤超濾組在T2、T3、T4、T5的IL-6、TNF-α顯著低于對照組和改良超濾組,P<0.05.結論:複閤超濾能夠改善患兒肺的通氣功能和換氣功能,有效減輕全身炎癥反應,使患兒能在術後儘早脫機,減少CPB術後併髮癥,保護患兒肺功能.
목적:탐토부합초려대영유인체외순배술후폐공능적영향.방법:선취아원2008년8월지2012년2월수치적300례복잡중증선천성심장병환인위연구대상,안조수궤원칙분위대조조、개량초려조화복합초려조,기중대조조재정개체외순배술과정중불사용초려,개량초려조재체외순배결속후채용개량초려,복합초려조재체외순배과정중응용평형초려,체외순배결속후개시운용개량초려,비교삼조환인재전류전(T1)、전류결속후20min(T2)、술후2h(T3)、술후6h(T4)、술후12h(T5)급술후24h(T6)시적조기량(TV)、호흡정돈압(Ppause)、기도봉압치(Ppeak)、호흡빈솔(F)、흡입양농도(FiO2)등폐공능지표적변화.병재측정이상6개시간점적백세포개소6(IL-6)、종류배사인자(TNF-α)적함량.결과:삼조환자술후적폐정태순응성(Cstat)、양합지수(OI)현저저우술전,폐포일동맥양분압(AaDO2)현저고우술전,P<0.05.복합초려조재T4、T5적Cstat、OI현저고우대조조화개량초려조,P<0.05,개량초려조적요현저고우대조조,P<0.05.복합초려조재T4、T5적AaD02현저저우대조조화개량초려조,P<0.05,개량초려조적요현저고우대조조,P<0.05.삼조환인술후적IL-6、TNF-α현저고우술전,P<0.05.복합초려조재T2、T3、T4、T5적IL-6、TNF-α현저저우대조조화개량초려조,P<0.05.결론:복합초려능구개선환인폐적통기공능화환기공능,유효감경전신염증반응,사환인능재술후진조탈궤,감소CPB술후병발증,보호환인폐공능.
Objective:To study accord with ultrafiltration in infants and young children extracorporeal circulation after the influence of lung function. Methods:Select from August 2008 to February 300 cases were complicated severe congenital heart disease children as the research object, according to the principle of random divided into control group, improved ultrafiltration group and composite ultrafiltration group, the control group in the whole extracorporeal circulation technique process without the use of ultrafiltration, improved ultrafiltration group in extracorporeal circulation after modified ultrafiltration, composite ultrafiltration group in extracorporeal circulation in the process of using balance ultrafiltration, extracorporeal circulation after modified ultrafiltration, compare three groups in turn flow children before (T1), turn flow after 20 min (T2), postoperative 2 h (T3), postoperative 6 h (T4), postoperative 12 h (T5) and postoperative 24 h (T6) when the tide volume (TV), respiratory pause pressure (Ppause), airway peak voltage value (Ppeak), respiratory frequency (F), suction oxygen concentration (FiO2) and so on pulmonary function indexes to change. In the determination and above six time point of interleukin 6 (IL-6), tumor necrosis factor (TNF alpha) content. Results:Three groups of patients postoperative lung static compliance (Cstat), oxygenation index (OI) were significantly lower than, the alveolar a arterial oxygen partial pressure (AaDO2) were significantly higher, P<0.05. Composite ultrafiltration group in T4, T5 of Cstat, OI significantly higher than those in the control group and improved ultrafiltration group, P<0.05, improved ultrafiltration group to a significantly higher than those in the control group, P<0.05. Composite ultrafiltration group in T4, T5 of AaD02 significantly lower than those of the control group and improved ultrafiltration group, P<0.05, improved ultrafiltration group to a significantly higher than those in the control group, P<0.05. Three groups of postoperative IL-6, TNF alpha significantly higher than preoperative, P<0.05. Composite ultrafiltration group in T2, T3, T4, T5 of IL-6, TNF alpha significantly lower than those of the control group and improved ultrafiltration group, P<0.05.Conclusion:Composite ultrafiltration can children improve pulmonary ventilation function and ventilation function, effectively reduce systemic inflammatory response, so that children can as soon as possible in the offline, reduce CPB postoperative complications, pulmonary function to protect children.
