本文選題：負平衡超濾　切入點：改良超濾　出處：《中國現(xiàn)代醫(yī)學雜志》2015年14期

【摘要】：目的觀察負平衡超濾聯(lián)合改良超濾對瓣膜置換患者術后肺功能和早期認知功能的影響。方法 60例擇期行二尖瓣置換術的患者分為常規(guī)超濾組(CUF組)和負平衡超濾+改良超濾組(S+M組),每組各30例。CUF組于復溫后開始超濾,轉流結束前停止超濾;S+M組轉流開始10 min后行負平衡超濾,停機后行改良超濾。于轉流前(T1)、轉流結束即刻(T2)、術后2(T3)、12(T4)和24 h(T5)取動脈血標本,做血氣分析并測定腫瘤壞死因子-α(TNF-α)及白細胞介素-6(IL-6)的濃度;記錄T1~T5各時間氣道峰壓(Peak)、呼吸停頓壓(Ppause)、潮氣量(TV)和吸入氧濃度(Fi O),計算肺靜態(tài)順應性(CLst)2、肺泡-動脈氧分壓梯度(Aa DO2)及氧合指數(shù)(OI)。記錄兩組患者術中超濾量、清醒時間、呼吸機輔助呼吸時間。于麻醉前24 h、術后24、48和72 h時用簡易精神狀態(tài)量表(MMSE)測試患者的認知功能,記錄術后72 h內術后認知功能障礙(POCD)的發(fā)生率。于轉流前、超濾前及超濾后取動脈血,測定各時點患者血漿膠體滲透壓(COP)及紅細胞壓積(Hct)。結果與T1相比,在T2~T5時兩組患者CLst和OI均降低,Aa DO2、血漿內TNF-α及IL-6的濃度均升高;與CUF比較,在T2~T5時S+M組患者CLst和OI升高,Aa DO2、血漿內TNF-α及IL-6的濃度均降低,差異有統(tǒng)計學意義(P0.05);與CUF組比較,S+M組患者超濾量明顯增多,術后患者的清醒時間、呼吸機輔助時間均減少,差異有統(tǒng)計學意義(P0.05);與術前24 h比較,兩組患者術后24、48和72 h時的MMSE評分值均降低;與CUF組比較,S+M組患者術后48和72 h時MMSE評分值增加,術后72 h內POCD的發(fā)生率明顯降低,差異有統(tǒng)計學意義(P0.05)。超濾后S+M組患者血漿COP和Hct與CUF組相比均明顯升高;兩組患者超濾前后血漿COP、Hct比較均明顯升高,差異有統(tǒng)計學意義(P0.05)。結論術中使用負平衡超濾聯(lián)合改良超濾可改善瓣膜置換患者術后肺功能和早期認知功能,有利于患者術后恢復。
[Abstract]:Objective to observe the effects of negative balance ultrafiltration combined with modified ultrafiltration on pulmonary function and early cognitive function after valve replacement.Methods Sixty patients undergoing elective mitral valve replacement were divided into conventional ultrafiltration group (CUF group) and negative balance ultrafiltration modified ultrafiltration group (S-M group).Before the end of bypass flow, the ultrafiltration of group S M was stopped 10 min after the start of the bypass, then negative balance ultrafiltration was performed, and then the modified ultrafiltration was performed after stopping.The arterial blood samples were collected before bypass, and the concentrations of tumor necrosis factor- 偽 (TNF- 偽) and interleukin-6 (IL-6) were measured.Peak airway pressure (Peak), respiratory standstill pressure (T1~T5), tidal volume (TTV) and inhaled oxygen concentration (T1~T5) were recorded at each time. The pulmonary static compliance and pulmonary alveola-artery oxygen pressure gradient (AaDO2) and oxygenation index (Oi) were calculated.Ultrafiltration, waking time and ventilator assisted breathing time were recorded in both groups.The cognitive function of the patients was measured by MMSE at 24 h before anesthesia, 24 h and 72 h postoperatively, and the incidence of cognitive dysfunction (POCD) was recorded within 72 h after operation.Arterial blood was taken before, before and after ultrafiltration. Plasma colloidal osmotic pressure (COP) and HCT were measured at different time points.The difference was statistically significant (P 0.05), compared with that in CUF group, the ultrafiltration volume in S M group was significantly increased, the waking time and ventilator assistant time were decreased, and the difference was statistically significant (P 0.05), compared with 24 hours before operation, there was no significant difference between the two groups.Compared with the CUF group, the MMSE score increased at 48 and 72 hours after operation, and the incidence of POCD decreased significantly at 72 hours after operation in both groups, and the difference was statistically significant (P 0.05).The levels of plasma COP and Hct in S M group after ultrafiltration were significantly higher than those in CUF group, and there was a significant difference between the two groups before and after ultrafiltration, and the difference was statistically significant (P 0.05).Conclusion negative balance ultrafiltration combined with modified ultrafiltration can improve pulmonary function and early cognitive function in patients with valvular replacement.
【作者單位】： 廣西醫(yī)科大學第一附屬醫(yī)院心血管病研究所導管手術麻醉室;
【分類號】：R614

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本文編號：1687326