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目的探讨变温式改良超滤对婴幼儿心脏手术预后的影响。方法选择同一外科组先天性心脏病患儿20例,配对法平均分为两组。两组均在体外循环(extracorporeal circulation,ECC)停止后开始超滤。改良超滤组血液未经变温直接进入右房;变温式改良超滤组血液变温后汇入右房。观察两组患儿超滤前后的体温和红细胞比积(Hct)、超滤量、超滤时间、术后出血量、红细胞悬液和血浆用量、正性肌力药使用时间和ICU停留时间。结果20例患儿无一例死亡。超滤后体温在改良超滤组显著下降(P<0.01),而变温式改良超滤组与超滤前无差异,显著高于改良超滤组(P<0.01)。变温式改良超滤组的超滤时间、术后出血量、血浆及红细胞悬液用量和正性肌力药使用时间,均显著低于改良超滤组(P<0.05)。结论变温式改良超滤能保持体温恒定,缩短超滤时间,减少术后出血和输血量,促进心功能的恢复,从而改善患儿预后。
Objective To investigate the effect of modified temperature modified ultrafiltration on the prognosis of infantile cardiac surgery. Methods Twenty children with congenital heart disease in the same surgical group were selected and divided into two groups equally. Both groups began ultrafiltration after cardiopulmonary bypass (extracorporeal circulation, ECC) ceased. Improved ultrafiltration group of blood without temperature directly into the right atrium; variable temperature modified ultrafiltration group of blood into the right atrium after warming. The body temperature and hematocrit (Hct), ultrafiltration volume, ultrafiltration time, postoperative blood loss, erythrocyte suspension and plasma volume, inotropic drug use time and ICU residence time were observed before and after ultrafiltration in both groups. Results 20 cases of children without death. After ultrafiltration body temperature in the modified ultrafiltration group decreased significantly (P <0.01), while the variable temperature improved ultrafiltration group and ultrafiltration no difference was significantly higher than the modified ultrafiltration group (P <0.01). The ultrafiltration time, postoperative blood loss, plasma and erythrocyte suspensions and time of inotropic drug use in the modified ultrafiltration group were significantly lower than those in the modified ultrafiltration group (P <0.05). Conclusions Modified temperature-controlled ultrafiltration can keep the body temperature constant, shorten the ultrafiltration time, reduce postoperative bleeding and blood transfusion, and promote the recovery of cardiac function, so as to improve the prognosis of children.