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目的观察改良超滤对心脏手术患儿呼吸动力学的影响。方法2005-03—2006-02山东大学山东省立医院收治60例先天性心脏病患儿,将患儿分为对照组、平衡超滤组(BUF)和改良超滤组(MUF),每组20例。对照组行常规体外循环,平衡超滤和改良超滤组分别在体外循环中应用平衡超滤和改良超滤,在转流前(T1)、转流结束后20min(T2)、术后2h(T3)、术后6h(T4)、术后12h(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(FiO2)和吸气比例(insp%)。结果各组体外循环术后较术前的肺静态顺应性、气道阻力、肺泡-动脉氧分压、氧合指数都有明显变化,但是超滤组的变化小于对照组。在T3、T4、T5时间MUF组肺静态顺应性和氧合指数明显高于BUF组和对照组,气道阻力和肺泡-动脉氧分压梯度明显低于BUF组和对照组。结论改良超滤技术能够改善体外循环术后肺的呼吸动力学,对肺的通气功能和换气功能都有良好的保护作用。
Objective To observe the effect of modified ultrafiltration on respiratory dynamics in children undergoing cardiac surgery. Methods From March 2005 to February 2006, Shandong Provincial Hospital of Shandong Province admitted 60 children with congenital heart disease. The children were divided into control group, balanced ultrafiltration group (BUF) and modified ultrafiltration group (MUF) 20 cases. The patients in control group underwent routine cardiopulmonary bypass, balanced ultrafiltration and modified ultrafiltration were respectively treated with balanced ultrafiltration and modified ultrafiltration before cardiopulmonary bypass (T1), 20min after end of commutation (T2) and 2h after operation (Ppeak, Ppause, tidal volume (TV), respiration rate (F), FiO2 (FiO2)) were measured at 6h (T4) and 12h ) And inspiratory percentage (insp%). Results Compared with preoperative pulmonary static compliance, airway resistance, alveolar-arterial oxygen partial pressure and oxygenation index, the change of ultrafiltration group was less than that of control group. At T3, T4, and T5, the static compliance and oxygenation index of lung in MUF group were significantly higher than those in BUF group and control group. The airway resistance and alveolar-arterial oxygen partial pressure gradient were significantly lower than those in BUF group and control group. Conclusion The modified ultrafiltration technique can improve pulmonary respiratory dynamics after cardiopulmonary bypass, and has a good protective effect on ventilation and ventilatory function of lung.