Kameyama T, Ando F, Okamoto F, Hanada M, Yamanaka K, Sasahashi N, Hirose K, Matsuno S, Matsuura S
Department of Cardiovascular Surgery, Hyogo Prefectural Amaga-saki Hospital, Higashi-Daimotsu 1-1-1, Amagasaki 660-0828, USA.
Ann Thorac Cardiovasc Surg. 2000 Feb;6(1):19-26.
Since 1997 we have performed modified ultrafiltration (MUF) in pediatric open heart operations. To elucidate the clinical effects of MUF, patients under 20 kg in weight who underwent corrective open heart operation since 1997 are divided into 2 cohorts according to the enforcement of MUF (control group versus MUF group) retrospectively. Procedures, age, bodyweight, cardiopulmonary bypass (CPB) time, operation time, amount of donor blood use, postoperative inotrope dose, postoperative intubation time, and postoperative gas exchange capacity of lung expressed with respiratory index (RI) were compared between groups. Furthermore, a multiple linear regression analysis was performed to find independent correlates with postoperative RI. Finally scattergrams of intubation time and RI were drawn against several factors. In univariate analyses, the MUF group had significantly shorter intubation time and better RI. Multivariate analysis revealed that the enforcement of MUF was an independent correlate of postoperative RI. Analyses on the scattergrams revealed that the above mentioned favorable effects of MUF were prominent in the patients younger than 3 years or weighing less than 10 kg. We concluded that MUF had significant effects on pulmonary function preservation in pediatric open heart operations, especially for smaller children.
自1997年以来，我们在小儿心脏直视手术中实施了改良超滤（MUF）。为阐明MUF的临床效果，对1997年以来体重小于20kg且接受心脏直视矫正手术的患者，根据MUF的实施情况（对照组与MUF组）进行回顾性分组。比较两组之间的手术步骤、年龄、体重、体外循环（CPB）时间、手术时间、供血使用量、术后血管活性药物剂量、术后插管时间以及用呼吸指数（RI）表示的术后肺气体交换能力。此外，进行多元线性回归分析以找出与术后RI相关的独立因素。最后针对几个因素绘制插管时间和RI的散点图。单因素分析中，MUF组的插管时间显著缩短，RI更好。多因素分析显示MUF的实施是术后RI的独立相关因素。散点图分析显示，上述MUF的有利影响在3岁以下或体重小于10kg的患者中尤为突出。我们得出结论，MUF在小儿心脏直视手术中对肺功能的保护有显著效果，尤其是对年龄较小的儿童。
