不同超滤技术的临床应用

A comparative study of different ultrafiltration in clinic

  • 摘要: 目的: 探讨心肺转流(CPB)中应用不同超滤技术的适应证、最佳血液循环路径、技术实施要点及注意事项。方法: 回顾性总结、分析了364例在CPB中应用常规超滤(CUF)、改良超滤(MUF)和零平衡超滤(Z-BUF)的临床资料。比较滤液量、超滤前后的血球压积(Hct)、血钾浓度。结果: CUF组滤液量(1109± 781) ml,超滤前Hct 0.24 8±0.04 9,超滤后Hct 0.320±0.067。MUF组滤液量(28.4± 12.8) ml/kg,超滤前Hct 0.219±0.040,超滤后Hct 0.335±0.076,随着血液浓缩,动脉压逐步上升,术后气管插管留置时间明显缩短。Z-BUF组滤液量(2060±860) ml,超滤前血钾(6.69±0.4 6) mmol/L,超滤后血钾(5.32±0.38) mmol/L。本组有36例在停止CPB时液体出入量相等或负平衡,最多者-93ml/kg。术前有贫血(Hb≤100g/L)的9例在停止CPB时Hb均恢复或略高于术前水平。体重≤ 10㎏的婴幼儿仅在MUF中输注100~150ml的红细胞悬浮液。结论: CUF和MUF都能够滤除人工心肺系统中多余的水分,浓缩血液,减少因输注血液制品所带来的并发症。MUF在清除体内、外多余水分的同时还能改善术后早期血流动力学和器官功能。目前,MUF已成为我所婴幼儿CPB所必需。Z-BUF是治疗高血钾的有效措施之一。

     

    Abstract: Objective: To investigate indications of different ultrafiltration, simple and convenient blood shunt, key techniques and special precautions. Methods: To review the clinical data of 364 patients who used different ultrafiltration and analyze the ultrafiltrated volumes, hematocrits (Hct) and serum potassium. Results: The ultrafiltrated volumes was (1 109±781)ml and Hct changed from 0.248±0.049 to 0.320±0.067 during coventional ultrafiltration(CUF).By modified ultrafiltration(MUF), the ultrafiltrated volumes (28.4±12.8)ml/kg and Hct from 0.219±0.040 to 0.335 0.076. With blood concentrate, arterial pressure raised gradually and duration of endutracheal intubation was obviously shortened in postoperation. By zero-balanced ultrafiltration(Z-BUF), the ultrafiltrated volumes was (2 060±860)ml and serm potassium changed from(6.69±0.46)mmol/L to (5.32±0.38)mmol/L. In 36 cases the totally fluid volumes is balance or negative balance in the end of CPB, the most one–93 ml/kg. In 9 patients with anemia, Hb didn’t changed or increased. Infant whose weight was less 10kg accepted transfusion with 100~150 ml RBC. Conclusion: Both CUF and MUF can concentrate blood quickly, MUF yet improve early hemodynamics and organs function. MUF may be the chiefly choice in CPB of infant. Z-BUF is efficient to reduce high serum potassium.

     

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