Naik S K, Knight A, Elliott M
Cardiothoracic Unit, Hospital for Sick Children, London, UK.
Circulation. 1991 Nov;84(5 Suppl):III422-31.
Conventional ultrafiltration (UF) fails to reverse satisfactorily hemodilution and the rise in total body water (TBW) seen after cardiopulmonary bypass (CPB). We have modified the technique, timing, and placement of UF in the CPB circuit and in pilot studies observed controlled elevation of hematocrit and a significantly reduced rise in TBW. We have carried out a prospective randomized study in 50 children undergoing open-heart surgery, comparing modified UF (MUF) with nonfiltered controls. MUF was carried out for 10 minutes after completion of CPB to a hematocrit of 36-42. Fluid balance, TBW (by bioimpedance), and hemodynamics were recorded for 24 hours postoperatively. The results were analyzed using Mann-Whitney U test, comparing controls (n = 24) to ultrafiltered (n = 24). There was one death in each group. Blood loss (ml/kg/24 hr) was 19.5 median (range, 9-30) in the controls versus 12.5 (8-22) in MUF (p = 0.0002); blood transfused (ml/kg/24 hr) 15.5 (3-35) in controls versus 3 (0-11) in MUF (p = 0.0001); colloid transfused (ml/kg/24 hr) 12 (6-56) in controls versus 12 (0-28) in MUF (p = 0.18); percent rise in TBW 11.1 (4.3-16.8) in controls versus 4.0 (1.6-7.9) in MUF (p = 0.0001). There was rise in arterial blood pressure during MUF. Percent rise of systolic blood pressure was 1 (-4 to +9) in controls versus 49 (5-81) in MUF (p = 0.0001); percent rise in diastolic blood pressure 0 (-5 to +8) in controls versus 28 (3-47) in MUF (p = 0.0001). UF reduced the rise in TBW and donor blood requirement associated with CPB in children. The blood pressure rise observed during UF is as yet unexplained, but if proven safe the technique may permit donor blood-free cardiac surgery and prevent the accumulation of potentially dangerous excess tissue fluid.
传统超滤（UF）不能令人满意地逆转心肺转流（CPB）后出现的血液稀释及全身水含量（TBW）升高。我们对CPB回路中超滤的技术、时机和位置进行了改进，并在初步研究中观察到血细胞比容得到了可控性升高，TBW的升高也显著降低。我们对50例接受心脏直视手术的儿童进行了一项前瞻性随机研究，将改良超滤（MUF）与未进行超滤的对照组进行比较。在CPB完成后进行10分钟的MUF，使血细胞比容达到36 - 42。术后24小时记录液体平衡、TBW（通过生物电阻抗法测量）和血流动力学。使用曼-惠特尼U检验对结果进行分析，将对照组（n = 24）与超滤组（n = 24）进行比较。每组各有1例死亡。对照组的失血（ml/kg/24小时）中位数为19.5（范围9 - 30），而MUF组为12.5（8 - 22）（p = 0.0002）；对照组输注的血液量（ml/kg/24小时）为15.5（3 - 35），而MUF组为3（0 - 11）（p = 0.0001）；对照组输注的胶体量（ml/kg/24小时）为12（6 - 56），而MUF组为12（0 - 28）（p = 0.18）；对照组TBW的升高百分比为11.1（4.3 - 16.8），而MUF组为4.0（1.6 - 7.9）（p = 0.0001）。在MUF过程中动脉血压升高。对照组收缩压升高百分比为1（-4至 +9），而MUF组为49（5 - 81）（p = 0.0001）；对照组舒张压升高百分比为0（-5至 +8），而MUF组为28（3 - 47）（p = 0.0001）。超滤减少了儿童CPB相关的TBW升高和供血需求。超滤过程中观察到的血压升高目前尚无法解释，但如果被证明是安全的，该技术可能允许进行无供血心脏手术，并防止潜在危险的过多组织液积聚。
