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目的探讨零平衡超滤(ZBUF)、改良超滤(MUF)和常规超滤(CUF)联合应用对先天性心脏病(CHD)合并中重度肺动脉高压(PH)婴幼儿术后肺功能的保护效果。方法 24例体重<10 kg、CHD合并中重度PH在体外循环(CPB)下行心内直视手术的婴幼儿纳入本研究,CPB管路及超滤器连接采用Elliot方式,均衡分为两组。MUF+CUF组(n=12):常规库血预充,主动脉开放后行CUF,CPB结束后行MUF。ZBUF+MUF组(n=12):在常规库血预充的基础上进行ZBUF,CPB期间全程行ZBUF,CPB结束后行MUF。比较两组患儿预充液和围术期血气分析结果、预充液和术后血液中肿瘤坏死因子-α(TNF-α)含量、术后机械通气时间、ICU滞留时间及住院时间。结果 ZBUF+MUF组预充液中乳酸(Lac)、葡萄糖(Glu)和TNF-α等含量明显低于CUF+MUF组(P<0.05);围术期Lac、Glu、TNF-α较CUF+MUF组显著降低(P<0.01);术后机械通气时间两组无显著差异(P>0.05);术后多个时间点ZBUF+MUF组患儿呼吸指数明显低于CUF+MUF组(P<0.05);ICU监护时间、术后住院时间较CUF+MUF组显著缩短(P<0.05)。结论 ZBUF和MUF的联合使用能有效降低围术期代谢产物有害炎性介质的含量,有利于减轻低体重患儿术后肺损伤,改善临床预后。
Objective To investigate the protective effect of combined use of zero balance ultrafiltration (ZBUF), modified ultrafiltration (MUF) and conventional ultrafiltration (CUF) on pulmonary function in infants with congenital heart disease (CHD) complicated with moderate pulmonary hypertension (PH) . Methods Twenty-four infants and young children weighing less than 10 kg and undergoing CHD undergoing open heart surgery undergoing cardiopulmonary bypass (CPB) with CHD were enrolled in this study. The Elliot method was used to connect the CPB tubing and the ultrafilter. MUF + CUF group (n = 12): pre-charge of routine blood bank, CUF after open aorta and MUF after CPB. ZBUF + MUF group (n = 12): ZBUF was performed on the basis of routine blood pre-charge, ZBUF was performed during CPB, and MUF was performed after CPB. The blood gas analysis results of prefilled and perioperative period were compared between the two groups. The contents of tumor necrosis factor-α (TNF-α), postoperative mechanical ventilation, ICU retention time and hospitalization time were calculated. Results Compared with CUF + MUF group, the contents of Lac, Glu and TNF-α in prefilled liquid of ZBUF + MUF group were significantly lower than that of CUF + MUF group (P <0.05) (P <0.01). There was no significant difference in mechanical ventilation time between the two groups (P> 0.05). The respiration index of ZBUF + MUF group was significantly lower than that of CUF + MUF group at various time points after operation (P < 0.05). The ICU monitoring time and postoperative hospital stay were significantly shorter than those in CUF + MUF group (P <0.05). Conclusions The combined use of ZBUF and MUF can effectively reduce the perioperative metabolites of harmful inflammatory mediators, reduce postoperative lung injury in children with low body weight and improve clinical prognosis.