Department of Surgery, Discipline of Cardiac Surgery, Faculty of Medical Science, State University of Campinas, UNICAMP, Campinas, São Paulo, Brazil.
J Thorac Cardiovasc Surg. 2012 Sep;144(3):663-70. doi: 10.1016/j.jtcvs.2012.04.012. Epub 2012 May 9.
Modified ultrafiltration (MUF) has been shown to decrease the postcardiac surgery inflammatory response and to improve respiratory function and cardiac performance in pediatric patients; however, this approach has not been well established in adults. The present study hypothesized that MUF could decrease the postsurgical inflammatory response, leading to improved respiratory and cardiac function in adults undergoing coronary artery bypass grafting.
Sixty patients undergoing coronary artery bypass grafting were randomized to the MUF or control group (n = 30 each). MUF was performed for 15 minutes at the end of bypass. The following data were recorded at the beginning of anesthesia, end of bypass, end of experimental treatment, and 24 and 48 hours after surgery: alveolar-arterial oxygen gradient, red blood cell units transfused, chest tube drainage, hemodynamic parameters, and cytokine levels (interleukin-6, P-selectin, intercellular adhesion molecule, and soluble tumor necrosis factor receptor).
The MUF group displayed less chest tube drainage than the control group after 48 hours (598 ± 123 mL vs 848.0 ± 455 mL; P = .04) and less red blood cell transfusions (0.6 ± 0.6 units/patient vs 1.6 ± 1.1 units/patient; P = .03). Hematocrit level was higher in the MUF group than in the control group at the end of bypass (37.8% ± 1.1% vs 34.1% ± 1.1%; P < .05), but the levels were comparable at 48 hours. Similar values for interleukin-6 and P-selectin were observed at all stages. Plasma levels of intercellular adhesion molecule were higher in the MUF group than in the control group, particularly in the first sampling after experimental treatment (P = .01). Plasma levels of soluble tumor necrosis factor receptor were higher in the MUF group than in the control group at 48 hours. Hemodynamic and oxygen transport parameters were similar in both groups throughout the observation period. There were no differences in other clinical outcomes.
Use of MUF was associated with increased inflammatory response, reduced blood loss, and less blood transfusions in adults undergoing coronary artery bypass grafting.
改良超滤（MUF）已被证明可减少心脏手术后的炎症反应，并改善儿科患者的呼吸功能和心功能；然而，这种方法在成人中尚未得到很好的确立。本研究假设 MUF 可减少术后炎症反应，从而改善行冠状动脉旁路移植术的成人的呼吸和心功能。
60 例行冠状动脉旁路移植术的患者随机分为 MUF 组或对照组（每组 30 例）。在旁路结束时进行 15 分钟的 MUF。在麻醉开始时、旁路结束时、实验治疗结束时以及手术后 24 小时和 48 小时记录以下数据：肺泡-动脉氧梯度、红细胞单位输注量、胸腔引流管引流量、血流动力学参数和细胞因子水平（白细胞介素 6、P-选择素、细胞间黏附分子和可溶性肿瘤坏死因子受体）。
与对照组相比，MUF 组在术后 48 小时时胸腔引流管引流量更少（598±123mL 比 848.0±455mL；P=0.04），红细胞输注量更少（0.6±0.6 单位/患者比 1.6±1.1 单位/患者；P=0.03）。MUF 组在旁路结束时的血细胞比容高于对照组（37.8%±1.1%比 34.1%±1.1%；P<0.05），但在 48 小时时两组水平相当。在所有阶段，白细胞介素 6 和 P-选择素的数值相似。MUF 组的细胞间黏附分子的血浆水平高于对照组，尤其是在实验治疗后的第一次采样时（P=0.01）。MUF 组的可溶性肿瘤坏死因子受体的血浆水平在 48 小时时高于对照组。在整个观察期间，两组的血流动力学和氧转运参数相似。其他临床结局无差异。
在接受冠状动脉旁路移植术的成人中，使用 MUF 与炎症反应增加、失血减少和输血量减少有关。
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