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目的研究平衡超滤联合改良超滤对婴幼儿体外循环术后肺功能的影响。方法60例先天性心脏病患儿分为对照组(C)、改良超滤组(M)和平衡超滤联合改良超滤组(U)。C组体外循环中不使用超滤,M组在转流结束后应用改良超滤,U组在转流开始后进行平衡超滤,转流结束后进行改良超滤。分别在转流前(T1),转流结束后20min(T2),术后2 h(T3),术后6 h(T4),术后12 h (T5)测定记录气道峰压(Ppeak)、呼吸停顿压(Ppause)、潮气量(TV)、呼吸频率(F)、吸入氧浓度(FiO_2)和吸气比例(insp%)、动脉血中白介素6(IL-6)和白介素8(IL-8)的浓度。结果各组体外循环术后较术前的肺静态顺应性(Cstat)、气道阻力(Raw)、肺泡-动脉氧分压(AaDO_2)、氧合指数(OI)、IL-6及IL-8浓度都有明显变化。在T5时间U组的Cstat明显高于M组和C组,Raw明显低于M组和C组；在T4、T5时间U组的AaDO_2明显低于M组和C组,OI明显高于M组和C组；在T2、T3、T4、T5时间U组的IL-6和IL-8浓度明显低于M组和C组。结论体外循环手术中联合应用平衡超滤和改良超滤能改善患儿肺的通气功能和换气功能,并能降低血浆中的炎性因子的浓度,减轻炎性反应,保护肺功能。
Objective To study the effect of balanced ultrafiltration combined with modified ultrafiltration on pulmonary function in infants with cardiopulmonary bypass. Methods Sixty children with congenital heart disease were divided into control group (C), modified ultrafiltration group (M) and balanced ultrafiltration plus modified ultrafiltration group (U). In group C, ultrafiltration was not used during cardiopulmonary bypass. Modified ultrafiltration was applied in group M after the end of commutation. Balanced ultrafiltration was performed in group U after the start of commutation. Modified ultrafiltration was performed after the end of commutation. The peak airway pressure (Ppeak) was recorded before (T1), 20min (T2) after commutation, 2h after operation (T3), 6h after operation (T4) and 12h Ppause, TV, F, FiO 2, and insp%, arterial interleukin 6 (IL-6) and interleukin 8 (IL) -8). Results Compared with preoperative pulmonary static compliance (Cstat), airway resistance (Raw), alveolar-arterial oxygen pressure (AaDO_2), oxygenation index (OI), IL-6 and IL-8 Concentration has significant changes. At T5, the Cstat of U group was significantly higher than that of M group and C group, and Raw was significantly lower than that of M group and C group. At T4 and T5, Ua group had lower AaDO_2 than M group and C group, and OI was significantly higher than M group And group C, and the concentrations of IL-6 and IL-8 in group U at T2, T3, T4 and T5 were significantly lower than those in M and C groups. Conclusion The combined use of balance ultrafiltration and modified ultrafiltration during cardiopulmonary bypass can improve the lung ventilation and ventilation in children and reduce the concentration of inflammatory cytokines in the plasma, reduce the inflammatory reaction and protect the lung function.