CAJ | 학술논문

目的：探讨体外循环(cardiopulmonary bypass，CPB)中零平衡超滤(zero-balanced ultrafiltration， ZBUF)和改良超滤(modified ultrafiltration，MUF)联合应用对婴幼儿心脏手术后肺功能的影响。方法：60例接受先天性心脏病手术治疗的患儿，随机分为零平衡超滤组(Z组)、改良超滤组(M组)和零平衡超滤联合改良超滤组(Z+M组)。测定3组患儿CPB前(T1)、CPB后20 min(T2)、术后2 h(T3)、术后6 h(T4)和术后12 h(T5)的氧合指数、肺泡-动脉氧分压差、肺静态顺应性和气道阻力。记录3组患儿术后呼吸机辅助时间。结果：3组患儿CPB术后较CPB前的氧合指数和肺静态顺应性明显下降，气道阻力和肺泡-动脉血氧分压差明显升高(P<0.05)；在T3，T4和T5时，Z+M组的氧合指数和肺静态顺应性明显高于Z组和M组(P<0.05)，肺泡-动脉血氧分压差和气道阻力明显低于Z组和M组(P<0.05)；Z+M组术后呼吸机辅助时间比Z组和M组短(P<0.05)。结论：零平衡超滤和改良超滤联合应用能明显改善婴幼儿心脏手术后受损的肺功能。
목적：탐토체외순배(cardiopulmonary bypass，CPB)중령평형초려(zero-balanced ultrafiltration， ZBUF)화개량초려(modified ultrafiltration，MUF)연합응용대영유인심장수술후폐공능적영향。방법：60례접수선천성심장병수술치료적환인，수궤분위령평형초려조(Z조)、개량초려조(M조)화령평형초려연합개량초려조(Z+M조)。측정3조환인CPB전(T1)、CPB후20 min(T2)、술후2 h(T3)、술후6 h(T4)화술후12 h(T5)적양합지수、폐포-동맥양분압차、폐정태순응성화기도조력。기록3조환인술후호흡궤보조시간。결과：3조환인CPB술후교CPB전적양합지수화폐정태순응성명현하강，기도조력화폐포-동맥혈양분압차명현승고(P<0.05)；재T3，T4화T5시，Z+M조적양합지수화폐정태순응성명현고우Z조화M조(P<0.05)，폐포-동맥혈양분압차화기도조력명현저우Z조화M조(P<0.05)；Z+M조술후호흡궤보조시간비Z조화M조단(P<0.05)。결론：령평형초려화개량초려연합응용능명현개선영유인심장수술후수손적폐공능。
Objective: To determine the protective effect of zero-balanced ultraifltration and modiifed ultraifltration on infants’ pulmonary function atfer cardiac surgery. Methods: Sixty infants with congenital heart diseases were randomly divided into 3 groups: a zero-balanced ultraifltration group (Z group), a modiifed ultraifltration group (M group) and a zero-balanced ultraifltrationwith modified ultrafiltration group (Z+M group). Oxygenation index (OI), difference of alveoli-arterial oxygen pressure (P(A-α)O2), static lung compliance (Cstat), and airway resistance (Raw) were measured before caridopulmonary bypass (CPB, T1), 20 minutes atfer the CPB (T2), 2 h atfer the operation (T3), 6 h atfer the operation (T4) and 12 h atfer the operation (T5). hTe time of mechanical ventilation was also monitored. Results:Atfer the CPB, OI and Cstat in all groups decreased signiifcantly, while Raw and P(A-α)O2 increased signiifcantly. At T3, T4 and T5, OI and Cstat in the Z+M group were signiifcantly higher than those in the Z group and the M group (P<0.05), Raw andP(A-α)O2 in the Z+M group were signiifcantly lower than those in the Z group and the M group (P<0.05). hTe ventilation time in the Z+M group was signiifcantly shorter than that in the Z group and the M group (P<0.05). Conclusion:Zero-balanced ultrafiltration and modified ultrafiltration can effectively promote the pulmonary function atfer cardiac surgery in infants.