Takabayashi Shin, Shimpo Hideto, Yokoyama Kazuto, Iwata Hideki
Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie 514-8507, Japan.
Gen Thorac Cardiovasc Surg. 2007 Jan;55(1):12-8. doi: 10.1007/s11748-006-0067-5.
Modified ultrafiltration increases blood pressure after cardiopulmonary bypass in children. To investigate the cause of this hemodynamic improvement, we assessed the relationship between increased blood pressure and hematocrit.
We retrospectively assessed 30 consecutive patients who underwent ventricular septal defect closure, and divided them into two groups: group M (modified ultrafiltration, n=15) and group C (conventional ultra-filtration, n=15). We compared the intraoperative transitions of blood pressure and hematocrit, and analyzed the correlations between blood pressure and hematocrit at 15 min after cardiopulmonary bypass (immediately after modified ultrafiltration in group M) and between the percent increases in blood pressure and hematocrit during modified ultrafiltration.
Although intraoperative central venous pressure and dopamine dosage were similar, in group M, increases in hematocrit (26.4% +/- 4.9% to 31.9% +/- 5.7%, P < 0.01) and systolic blood pressure (61.1 +/- 10.3 to 75.6 +/- 11.5 mmHg, P < 0.01) occurred during modified ultrafiltration. Furthermore, diastolic and mean blood pressure at 15 min after cardiopulmonary bypass (after modified ultrafiltration) were higher in group M than in group C. However, systolic, mean, and diastolic blood pressure were not correlated with increased hematocrit after modified ultrafiltration, and there was also no correlation between the percent increases in each blood pressure and hematocrit.
Modified ultrafiltration increased blood pressure and hematocrit immediately after cardiopulmonary bypass in children. However, no correlations were detected between the increases in blood pressure and hematocrit. These results indicate hemoconcentration is not the major cause of the increased blood pressure during modified ultrafiltration.
改良超滤可提高儿童体外循环后的血压。为探究这种血流动力学改善的原因，我们评估了血压升高与血细胞比容之间的关系。
我们回顾性评估了连续30例接受室间隔缺损修补术的患者，并将他们分为两组：M组（改良超滤，n = 15）和C组（传统超滤，n = 15）。我们比较了术中血压和血细胞比容的变化，并分析了体外循环后15分钟（M组为改良超滤后即刻）时血压与血细胞比容之间的相关性，以及改良超滤期间血压升高百分比与血细胞比容升高百分比之间的相关性。
尽管术中中心静脉压和多巴胺用量相似，但在M组中，改良超滤期间血细胞比容升高（从26.4%±4.9%升至31.9%±5.7%，P < 0.01），收缩压升高（从61.1±10.3升至75.6±11.5 mmHg，P < 0.01）。此外，体外循环后15分钟（改良超滤后）M组的舒张压和平均血压高于C组。然而，改良超滤后收缩压、平均血压和舒张压与血细胞比容升高均无相关性，且各血压升高百分比与血细胞比容升高百分比之间也无相关性。
改良超滤可使儿童体外循环后即刻血压和血细胞比容升高。然而，未检测到血压升高与血细胞比容升高之间的相关性。这些结果表明血液浓缩不是改良超滤期间血压升高的主要原因。
