摘要
目的比较大容量零平衡超滤(ZBUF)应用于体外循环(CPB)下冠状动脉旁路移植术(CABG)与非体外循环下CABG(OPCABG)的炎性反应和临床效果。方法45例接受CABG的患者随机分为常规CPB组(A组),常规CPB+零平衡超滤组(B组)和非体外循环组(C组),每组各15例。ZBUF采用的滤器为滤过面积0.5m2,孔径允许65-kDa物质通过,B组体外循环全程采用勃脉力(P lasm alyte)等量置换滤出液。观察麻醉诱导前、术中、术后即刻、术后4 h、24 h血浆中白细胞介素(IL)-6、IL-8、肿瘤坏死因子-ɑ(TNF-ɑ)浓度,术后肺泡-动脉氧阶差、呼吸机支持时间及ICU停留时间。结果与麻醉诱导前相比,三组炎性介质术后均显著升高,持续到术后24 h,A组最明显,与另外两组比较有统计学意义。B组平均超滤4015 m l,术后早期炎性介质浓度明显低于另两组。B、C两组术后呼吸机支持时间和ICU停留时间显著少于A组。结论大容量零平衡超滤可有效滤出炎性介质,减轻CPB所致炎性反应,与非体外CABG相比,同样可缩短机械通气和ICU停留时间。
OBJECTIVE This study was performed to compare clinical effects and inflammatory mediator removal by high -volume, zero- fluid balance ultrafiltration （ZBUF） between on pump CABG and OPCABG. METHODS Forty -five adult patients undergoing CABG open -heart procedure were randomized to three group. A： conventional CABG （ on - pump, no ultrafiltration） , B group ： on - pump CABG with the zero - balance uhrafihration （ZBUF） and C group ： OPCABG. ZBUF was performed by using a 65 - kDa ultrafilter with 0.5 m^2 surface area,A volume of a balanced salt crystalloid solution （Plasmalyte） equal to the filtered blood volume was given to replace the fluid removed. Plasma interleukin IL - 6, IL - 8, and tumor necrosis factor（ α - TNF） were measured at before induction （ T1 ）, 10 min after onset of bypass （T2）, terminal of bypass （T3）, 4 h（T4） and 24 h （T5） postoperative. Postoperative alveolar- arterial oxygen gradient, time to intubation and ICU -stay were monitored. RESULTS The plasma concentration of inflammatory mediator were increased notably in three group after operation. Average volume of filtrate removed was 4105 ml in group B during ZBUF. In B group（ ZBUF）, the patients had a significant lower in IL -6,8 and TNF compared with group A and C in the early postoperative. The mechanical ventilation supporting time and ICU - stay in group B and C were significantly shorter than that in group A. CONCLUSION This study demonstrates that high - volume ZBUF is a effective strategy that can remove significant amounts of inflammatory mediators during ECC in on - pump CABG, and reduce the ICU - stay and duration of mechanical ventilation as same as in OPCABG.
出处
《中国体外循环杂志》
2009年第3期142-144,134,共4页
Chinese Journal of Extracorporeal Circulation
