联合超滤在10公斤以下婴幼儿先天性心脏病合并中重度肺动脉高压术中肺保护的研究

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〈10kg、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。

The lung protective effect of continues ultrafiltration on pediatric patients with moderate to severe pulmonary hypertension undergoing cardiac surgery: a controlled clinical trial

Objective To investigate the lung protective effect of continues ultrafiltration on pediatric patients with moderate to severe pulmonary hypertension undergoing cardiac surgery.Methods Twenty-four consecutive pediatric patients(body weight <10 kg) with congenital heart diseases and moderate to severe pulmonary hypertension scheduled for corrective surgery under cardiopulmonary bypass(CPB) were included in this study.The CPB system and ultrafiltration were configured as Elliot’s method.Patients were equally divided into two groups according to the different ultrafiltration procedure: in the MUF+CUF group(n=12),patients were treated with conventional ultrafiltration(CUF) during the cardiopulmonary period and modified ultrafiltration(MUF) after the CPB;while in the ZBUF+MUF group(n=12),patients were treated with zero-balanced ultrafiltration(ZBUF) both on prime solution before CPB and circulating blood during the whole CPB period,and MUF after CPB.Blood gas analysis,tumor necrosis factor alpha(TNF-α),post operative clinical parameters such as respiratory index,ventilation time,ICU time and hospital time were compared.Results There were no deaths or severe complications in both groups.The concentrations of lactate,glucose and TNF-α in theprime solution and the peri-operative blood samples of ZBUF+MUF group were significantly lower than that of MUF+CUF group(P<0.05).The post-operative ventilation time was similar in both groups,but serial respiratory indices were significantly lower in ZBUF+MUF group(P<0.05).The ICU time and post-operative hospital time were also shorter in ZBUF+MUF group compared with that in MUF+CUF group. Conclusion Continues ultrafiltraton can effectively decrease the peri-operative blood concentrations of metabolites and hazardous inflammatory factors in patients with moderate to severe pulmonary hypertension undergoing cardiac surgery.It can also provide some level of pulmonary protection and help to improve the clinical recovery.