Zobel G, Stein J I, Kuttnig M, Beitzke A, Metzler H, Rigler B
Department of Pediatric Cardiology, University of Graz, Austria.
J Thorac Cardiovasc Surg. 1991 Apr;101(4):593-7.
Eleven hypervolemic and oliguric children with low cardiac output after cardiac operations were treated by slow continuous ultrafiltration or continuous arteriovenous hemofiltration. A mean negative fluid balance of 1.63 +/- 0.37 ml/kg/hr (standard error of the mean [SEM]) significantly improved the hemodynamic status within 59 +/- 6.1 hours (SEM). Although the central venous pressure decreased significantly from 15.2 +/- 0.84 to 8.8 +/- 0.92 mm Hg (p less than 0.0001), the mean arterial pressure increased significantly from 41.5 +/- 2.54 to 53.5 +/- 2.21 mm Hg (p less than 0.001). In addition, pH increased significantly from 7.31 +/- 0.01 (SEM) to 7.43 +/- 0.001 (SEM) (p less than 0.001) and oxygenation index (arterial oxygen tension/inspired oxygen fraction) from 119 +/- 15.2 (SEM) to 214 +/- 27.0 (SEM) (p less than 0.001). Hemodynamic improvement during slow continuous extracorporeal fluid removal allowed a significant decrease of the catecholamine infusion rate. After normovolemia had been achieved, continuous arteriovenous hemofiltration had to be continued in four children because of persistent anuria. Eight patients could be weaned from artificial ventilation and vasopressor support. Two patients died without recovery of renal function and one with restored renal function. Slow continuous ultrafiltration and continuous arteriovenous hemofiltration improve the cardiovascular function in children with low cardiac output by optimizing the preload conditions of the failing heart. In addition, they improve acid-base balance and pulmonary gas exchange.
11名心脏手术后出现高血容量和少尿且心输出量低的儿童接受了缓慢持续超滤或持续动静脉血液滤过治疗。平均每小时负液体平衡量为1.63±0.37 ml/kg（均值标准误[SEM]），在59±6.1小时（SEM）内显著改善了血流动力学状态。尽管中心静脉压从15.2±0.84显著降至8.8±0.92 mmHg（p<0.0001），但平均动脉压从41.5±2.54显著升至53.5±2.21 mmHg（p<0.001）。此外，pH值从7.31±0.01（SEM）显著升至7.43±0.001（SEM）（p<0.001），氧合指数（动脉血氧分压/吸入氧分数）从119±15.2（SEM）升至214±27.0（SEM）（p<0.001）。缓慢持续体外液体清除过程中的血流动力学改善使儿茶酚胺输注速率显著降低。在达到血容量正常后，4名儿童因持续无尿而必须继续进行持续动静脉血液滤过。8名患者能够脱离人工通气和血管升压药支持。2名患者未恢复肾功能死亡，1名患者肾功能恢复。缓慢持续超滤和持续动静脉血液滤过通过优化衰竭心脏的前负荷条件来改善低心输出量儿童的心血管功能。此外，它们还改善酸碱平衡和肺气体交换。
