【摘要】 目的探讨超滤技术对体外循环(CPB)心脏瓣膜置换术中促炎性因子、血浆内皮素-1(ET-1)浓度的影响及改良超滤联合零平衡超滤技术对CPB肺功能的影响。方法选取接受CPB心脏瓣膜置换术患者63例,随机分成常规超滤组(D1)、改良超滤联合零平衡超滤组(D2)和对照组(C)。分别在麻醉诱导后(T1)、CPB超滤前(T2)、超滤毕即刻(T3)、术后2 h(T4)、8 h(T5)时间点采集动脉血测定ET-1、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)浓度,测定结果用Hct值校正,计算各时点肺泡氧合指数(OI)、呼吸指数(RI)、肺顺应性(Cstat)。结果 CPB开始后ET-1、TNF-α和IL-6的浓度均开始上升,但在T4、T5时点D2组明显低于D1组、C组(P<0.05)。三组患者的肺泡OI在CPB后比麻醉诱导时均发生不同程度的降低,但对照组降低更明显(P<0.05)。D2组Cstat明显高于D1、C组。结论复合超滤较单一超滤方法能较好降低体内EF-1及炎性介质因子浓度,可改善体外循环瓣膜置换术患者术后肺功能。更多还原

【Abstract】 Objective To explore the effect of ultrafiltration technology on concentration of proinflammatory factors, endothelin-1（ET-1） with cardiac valvular replacement under cardiopulmonary bypass（CPB） as well as the effect of combined application of zero-balanced ultrafiltration and modified ultrafiltration on pulmonary function under CPB. Methods A total of 63 cases of patients undergoing heart valve replacement surgery under CPB were randomly divided into three groups: conventional ultrafiltration group（group D1）, zero-balanced with modified ultrafiltration group（group D2） and control group（group C）. T_he concentration of ET-1, tumor necrosis factor-α（T_NF-α） and interleukin-6（IL-6） were respectively measured at several time points in the three groups: after anesthesia induction（T₁）, before ultrafiltration under CPB（T₂）, after ultrafiltration immediately（T₃） and 2 h（T₄） and 8 h（T₅） after surgery. Also the determination results were corrected with Hct value. T_he alveolar oxygenation index（OI）, respiratory index（RI） and static lung compliance（Cstat） at several time points were reckoned. Results T_he concentration of T_NF-α, ET-1 and IL-6 all increased at the beginning of CPB. But the concentration of T_NF-α, ET-1 and IL-6 in group D2 were significantly lower than those in group D1 and group C at T₄ and T₅（P <0.05）.Compared with anesthesia induction, alveolar OI of patients in three groups after CPB decreased differently, and that in group C decreased more significantly（P <0.05）. Cstat in group D2 was significantly higher than that of group D1 and group C. Conclusions Compared with single ultrafiltration, combined ultrafiltration can reduce in vivo concentration of ET-1 and inflammatory factors preferably and can protect pulmonary function of patients with valve replacement under CPB.更多还原