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目的对比研究体外循环(CPB)中联合超滤方法和常规超滤方法对低龄低体质量婴幼儿心脏手术后肺功能的影响。方法将40例6 kg以下行心脏手术的婴幼儿患者分为联合组(n=20)和常规组(n=20),联合组采用零平衡超滤、常规超滤和改良超滤,常规组仅做常规超滤。观测两组患儿的超滤液量、血液浓缩指标、术后呼吸功能{氧合指数、肺泡-动脉氧分压差[(A-a)DO2]}、肺的静态顺应性、呼吸机通气时间和ICU停留时间。结果联合组患者用血量明显少于常规组,联合组患者血浆蛋白和红细胞比容(HCT)明显高于常规组。联合组患者术后肺的通气和换气功能均获改善。联合组患者术后白细胞和中性粒细胞均低于常规组。结论联合超滤方法在血液浓缩、降低白细胞和中性粒细胞等炎性介质方面明显优于常规超滤,能明显改善低龄低体质量婴幼儿的肺功能。
Objective To compare the effects of combined ultrafiltration and conventional ultrafiltration in cardiopulmonary bypass (CPB) on pulmonary function in infants and young children undergoing cardiac surgery. Methods Forty infants and young children under 6 kg cardiac surgery were divided into two groups: the combined group (n = 20) and the conventional group (n = 20). The combination group was treated with zero balance ultrafiltration, conventional ultrafiltration and modified ultrafiltration. Only regular ultrafiltration. The ultrafiltrate volume, concentration of blood, index of postoperative respiratory function {oxygenation index, alveolar-arterial oxygen pressure difference [(Aa) DO2]}, static lung compliance, ventilator ventilation time and ICU stay time. Results The blood volume of patients in combination group was significantly less than that of conventional group. The plasma protein and hematocrit (HCT) in combination group were significantly higher than those in conventional group. Ventilation and ventilation were improved in the lungs of patients in the combined group. The combined group of patients with postoperative leukocytes and neutrophils were lower than the conventional group. Conclusion The combined ultrafiltration method is superior to conventional ultrafiltration in blood concentration and reducing the inflammatory mediators such as leucocytes and neutrophils, and can significantly improve the lung function of infants with low birth weight and low birth weight.