Department of Cardiovascular Surgery, Xijing Hospital, Xi'an, China; Department of Cardiac Surgery, Affiliated Bayi Children's Hospital of General Hospital of Beijing Military Region, Beijing, China.
J Cardiothorac Vasc Anesth. 2013 Oct;27(5):897-902. doi: 10.1053/j.jvca.2013.01.006. Epub 2013 Jun 18.
To investigate the clinical effects of a combined ultrafiltration strategy on the surgical treatment of pediatric patients with congenital heart diseases.
A prospective, randomized, controlled study.
A single-institution study in an affiliated hospital of a university.
Sixty-five pediatric patients who underwent open heart surgery with cardiopulmonary bypass (CPB) to treat congenital heart disease were enrolled. The participants were randomized into 2 groups: conventional + modified ultrafiltration (MUF) (CM) group and prime + zero-balanced + MUF (PZM) group.
In the CM group (n = 33), conventional ultrafiltration was performed after removal of the aortic clamp, and MUF was performed after the completion of CPB. In the PZM group (n = 32), ultrafiltration was performed for the circuit prime solution, zero-balance ultrafiltration was performed after removal of the aortic clamp, and MUF was performed after the completion of CPB.
The blood gas parameters and tumor necrosis factor alpha content in the priming solution and perioperative blood samples were analyzed. Postoperative parameters, including mechanical ventilation time, respiratory indices, intensive care unit time, and hospital time, also were recorded. One hospital death occurred in each group. No severe complications occurred in either group. The lactic acid, glucose, and tumor necrosis factor alpha contents in the priming solution and perioperative blood samples were significantly lower in the PZM group compared with the CM group. The respiratory indices were statistically significantly better in the PZM group compared with the CM group in the early postoperative period. No significant differences were found between the 2 groups regarding the postoperative ventilation time, inotropic support, homologous blood transfusion, drainage, intensive care unit time, or postoperative hospital time.
The combined use of ultrafiltration of prime solution, zero-balance ultrafiltration, and MUF strategy is associated with a modest improvement in pulmonary function compared with the combination of conventional and MUF strategies in the early postoperative period, but the principal clinical outcomes are similar.
探讨超滤策略联合应用于小儿先天性心脏病体外循环心脏直视手术的临床效果。
前瞻性、随机、对照研究。
一所大学附属医院的单中心研究。
纳入 65 例行体外循环心脏直视手术治疗先天性心脏病的小儿患者。患者随机分为常规+改良超滤（CM）组和预充液+零平衡+改良超滤（PZM）组，每组 33 例和 32 例。
CM 组在主动脉阻断钳开放后进行常规超滤，CPB 结束后行改良超滤；PZM 组预充液行超滤，主动脉阻断钳开放后行零平衡超滤，CPB 结束后行改良超滤。
分析预充液及围术期血样血气分析和肿瘤坏死因子α（TNF-α）含量，记录术后机械通气时间、呼吸指数、重症监护病房（ICU）时间和住院时间等。
两组各死亡 1 例。两组均无严重并发症发生。与 CM 组比较，PZM 组预充液和围术期血样乳酸、葡萄糖和 TNF-α含量较低，术后早期呼吸指数较好。两组术后通气时间、正性肌力药物支持、同型输血、引流、ICU 时间及术后住院时间比较差异均无统计学意义。
与常规+改良超滤策略联合应用比较，预充液零平衡超滤联合改良超滤策略可改善术后早期肺功能，但主要临床结局相似。
