改良超滤对心脏瓣膜置换术后心肺功能的影响

目的 探讨改良超滤(modified ultrafiltration,MUF)对成人心脏瓣膜置换术后心肺功能的影响.方法 67例成人心脏瓣膜置换术患者随机分为MUF组(n=33)和无超滤对照组(n=34),动态观察体外循环(cardiopulmonary bypass,CPB)前、CPB停机时及MUF结束时(对照组在CPB停机20 min)血气氧分压及二氧化碳分压、术后呼吸机辅助呼吸时间、血管活性药物用量及使用时间、心脏射血分数等心肺功能指标.结果 CPB前与CPB停机时相比氧分压明显下降,组内差别显著,有统计学意义;组间差别不显著,无统计学意义.MUF组超滤后氧分压明显回升,接近体外循环前水平,无超滤对照组氧分压轻度回升,仍明显低于体外循环前.体外循环停机20 min时MUF组氧分压明显高于无超滤对照组,两者差别显著,有统计学意义(P=0.04);体外循环后二氧化碳分压轻度升高,改良超滤后二氧化碳分压轻度下降,但组内、组间差别均无统计学意义.术后MUF组呼吸机辅助时间、血管活性药物用量及使用时间明显低于无超滤对照组,两者差别显著,有统计学意义(P=0.00,P=0.00和P=0.01).术后1周心脏超声检查示两组心脏射血分数均较术前明显提高,但组间差别无统计学意义(P=0.58).结论 改良超滤有利于改善成人心脏瓣膜置换术后早期心肺功能.

EFFECT OF MODIFIED ULTRAFILTRATION ON HEART AND LUNG FUNCTION AFTER CARDIAV VALVE REPLACEMENT

ObjectiveTo investigate the effect of modified ultrafiltration(MUF) on heart and lung function after cardiac valve replacement.MethodsSixty-seven cases of adult patients undergoing valves replacement were randomized into modified ultrafiltration(MUF) group(n=33) and control group(n=34).Blood gas parameter such as PO_2,PCO_2 were measured at pre-cardiopulmonary bypass(CPB),end CPB,and post MUF(or 20 min post CPB in control group).Ventilatory support time,usage time and amount of vasoactive drug and ejection fraction(EF) of left ventricular were also measured in the early period of operation.ResultsPO_2 decreased obviously at the end of CPB.There were statistical differences in each group between pre-CPB and end CPB,but no statistical differences between two groups at pre-CPB and end CPB.After modified ultrafiltration PO_2 increased obviously and turned back to the level of pre-CPB.In control group PO_2 increased slightly 20 minute after CPB and was still lower than pre-CPB.PO_2 was higher in MUF group than in control group 20 min post CPB(P=(0.04)).PCO_2 increased slightly at the end of CPB and decreased slightly after MUF or 20 min post CPB in two groups,but there were no statistical differences in each group and between two groups at pre-CPB,end CPB and post MUF or 20 min post CPB.There were statistical differences in ventilatory support time,usage time and amount of vasoactive drug(P=(0.00),P=(0.00) and P=(0.01)),which were lower significantly in MUF group.EF of left ventricular increased significantly but there were no statistical differences between two groups 1 week after operation(P=(0.58)).ConclusionModified ultrafiltration could improve heart and lung function in early time after cardiac valve replacement.