儿童体外循环后静脉-静脉改良超滤：一项前瞻性随机研究。

Venovenous modified ultrafiltration after cardiopulmonary bypass in children: a prospective randomized study.

作者信息

Hennein H A, Kiziltepe U, Barst S, Bocchieri K A, Hossain A, Call D R, Remick D G, Gold J P

机构信息

Schneider Children's Hospital of the Long Island Jewish Medical Center, University of Michigan Medical Center, and the Albert Einstein College of Medicine, New Hyde Park, NY, USA.

出版信息

J Thorac Cardiovasc Surg. 1999 Mar;117(3):496-505.

PMID:10047653

Abstract

BACKGROUND

Cardiopulmonary bypass is associated with the production of both proinflammatory and anti-inflammatory cytokines, the balance of which leads to varying degrees of postoperative systemic inflammation. Arteriovenous modified ultrafiltration effectively reduces total body water and improves postoperative hemodynamic and homeostatic functions. Venovenous modified ultrafiltration is a modification of this technique, which has the potentially added advantage of eliminating the obligatory left-to-right shunt associated with arteriovenous modified ultrafiltration. We tested the hypothesis that venovenous modified ultrafiltration is a safe and effective method of achieving ultrafiltration in children after cardiopulmonary bypass.

METHODS

Thirty-eight pediatric patients were randomly assigned to undergo conventional, venovenous (n = 13), or no ultrafiltration venovenous (n = 13), and controls (n = 12). Perioperative, cardiopulmonary, and cytokine (tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, interleukin-8, and interleukin-10) data were collected for statistical analysis.

RESULTS

Compared with patients in the conventional ultrafiltration and control groups, patients undergoing venovenous modified ultrafiltration had the greatest volume of ultrafiltrate removed (46. 9 +/- 8.4 mL/kg vs 20.1 +/- 5.0 mL/kg and 0 mL/kg for conventional ultrafiltration and control groups, respectively; P =.0001), least increase in total body water (1.91% +/- 1.49% vs 3.90% +/- 1.86% and 8.24% +/- 3.41%; P =.05), greatest rise in hematocrit (39.7% +/- 1. 7% vs 33.8% +/- 2.1% and 29.6% +/- 2.3%; P =.006), and shortest length of hospital stay (4.41 +/- 0.28 days vs 6.69 +/- 1.47 days and 8.38 +/- 1.11 days; P =.03, P =.03).

CONCLUSIONS

Venovenous modified ultrafiltration is a safe and effective method of reducing the increase in total body water and duration of postoperative convalescence after cardiopulmonary bypass.

摘要

背景

体外循环与促炎和抗炎细胞因子的产生有关，两者的平衡导致不同程度的术后全身炎症反应。动静脉改良超滤可有效减少体内总水量，并改善术后血流动力学和内稳态功能。静脉-静脉改良超滤是该技术的一种改良，它可能具有消除与动静脉改良超滤相关的强制性左向右分流这一额外优势。我们检验了以下假设：静脉-静脉改良超滤是体外循环后儿童实现超滤的一种安全有效的方法。

方法

38例儿科患者被随机分为接受传统超滤组、静脉-静脉超滤组（n = 13）、无超滤静脉-静脉组（n = 13）和对照组（n = 12）。收集围手术期、心肺和细胞因子（肿瘤坏死因子-α、白细胞介素-1β、白细胞介素-6、白细胞介素-8和白细胞介素-10）数据进行统计分析。

结果

与传统超滤组和对照组患者相比，接受静脉-静脉改良超滤的患者超滤量最大（分别为46.9±8.4 mL/kg、传统超滤组为20.1±5.0 mL/kg、对照组为0 mL/kg；P = 0.0001），体内总水量增加最少（1.91%±1.49%、传统超滤组为3.90%±1.86%、对照组为8.24%±3.41%；P = 0.05），血细胞比容升高最大（39.7%±1.7%、传统超滤组为33.8%±2.1%、对照组为29.6%±2.3%；P = 0.006），住院时间最短（4.41±0.28天、传统超滤组为6.69±-1.47天、对照组为8.38±1.11天；P = 0.03，P = 0.03）。