CAJ | 학술논문

目的：比较两种不同置换液在患儿大容量零平衡超滤（ZBUF）中的效果。 　　方法：2012-11至2014-02选取主动脉缩窄深低温停循环手术的患儿40例，随机分为勃脉力A置换液组（n=21）和改良置换液组（n=19），均在复温阶段以15~20 ml/kg流量行ZBUF，直至直肠温34℃停止。分别于转机前（T1），开放升主动脉并补充完Ca剂之后5分钟（T2），ZBUF结束（T3），停机后（T4）检测血气。记录术中体外循环相关时间，观察并发症及术后恢复情况。 　　结果：两组术中血气结果比较：T3时改良置换液组患者的血气Ca离子浓度明显高于勃脉力A置换液组（P<0.01），碱剩余于T3时均呈负数且绝对值改良置换液组明显小于勃脉力A置换液组（P<0.05），而T1，T2，T4差异均无统计学意义（P>0.05）；其余各项指标组间比较差异均无统计学意义（P>0.05）。两组术后恢复指标均无统计学差异（P>0.05）。 　　结论：使用改良置换液较勃脉力可显著避免钙离子浓度降低和酸中毒，能为患者提供相对稳定的内环境。
목적：비교량충불동치환액재환인대용량령평형초려（ZBUF）중적효과。 　　방법：2012-11지2014-02선취주동맥축착심저온정순배수술적환인40례，수궤분위발맥력A치환액조（n=21）화개량치환액조（n=19），균재복온계단이15~20 ml/kg류량행ZBUF，직지직장온34℃정지。분별우전궤전（T1），개방승주동맥병보충완Ca제지후5분종（T2），ZBUF결속（T3），정궤후（T4）검측혈기。기록술중체외순배상관시간，관찰병발증급술후회복정황。 　　결과：량조술중혈기결과비교：T3시개량치환액조환자적혈기Ca리자농도명현고우발맥력A치환액조（P<0.01），감잉여우T3시균정부수차절대치개량치환액조명현소우발맥력A치환액조（P<0.05），이T1，T2，T4차이균무통계학의의（P>0.05）；기여각항지표조간비교차이균무통계학의의（P>0.05）。량조술후회복지표균무통계학차이（P>0.05）。 　　결론：사용개량치환액교발맥력가현저피면개리자농도강저화산중독，능위환자제공상대은정적내배경。
Objective:To compare the clinical effects of high volume zero-balanced ultraifltration (ZBUF) with different replacement lfuid in infant patients. Methods: A total of 40 infant patients who received aortic coarctation with deep hypothermic circulatory arrest operation in our hospital from 2012-11 to 2014-02 were summarized. The patients were randomized into 2 groups, Group A, the patients had ZBUF with plasmalyte A, n=21 and Group B, the patients had ZBUF with modiifed replacement lfuid n=19. All patients received ZBUF (15-20) ml/kg during re-warming period until the temperature reached 34°C at rectum. Blood gas analysis were conducted at 4 time points as T1 (before CPB), T2 (open ascending aorta and 5 min after calcium perfusion), T3 (ifnishing ZBUF) and T4 (end of CPB). The intra-operative CPB time and the post-operative recovery with the complication were recorded in all patients. Results: For blood gas analysis, the calcium concentration was higher in Group B than that in Group A at T3 time point, P<0.01 and the base excess was higher in Group A than that in Group B at T3 time point, P<0.05. Those indexes were similar at T1, T2 and T4, all P>0.05. The other indexes were similar between 2 groups, P>0.05 and the post-operative recovery was similar between 2 groups, P>0.05. Conclusion: ZBUF with modiifed replacement lfuid could avoid decreased calcium concentration and acidosis, therefore, provide a relative stable homeostasis in infant patients.