Ad N, Snir E, Katz J, Birk E, Vidne B A
Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Israel.
Isr J Med Sci. 1996 Dec;32(12):1326-31.
The use of cardiopulmonary bypass (CPB) in children is associated with significant morbidity due to the accumulation of an excessive amount of water. This can be decreased by massive diuresis, peritoneal dialysis, or conventional ultrafiltration technique (CUF) during bypass. However, we were dissatisfied with their effect on the outcome of our young patients, and recently began to use the modified technique of ultrafiltration (MUF) with good results. MUF was carried out for 15 min after completion of CPB to a hematocrit of 40%. Eighty patients were equally divided into two groups--MUF (group A) and control (group B)--and prospectively studied. There was one death in group A and two deaths in group B. The chest was left open in one patient in group A and in three patients in group B. At the end of MUF, the cardiac size was smaller, performance was better, and systemic blood pressure was higher in group A. Hematocrit levels in the two groups were similar during preoperative and CPB time, but post-CPB hematocrit in group A was significantly higher, 39.4% mean (range 35-50) vs. 28.5 (range 22-38) in group B (P <0.05). Blood loss was 10.56 ml/kg per 24 h (2-48.7) in group A vs. 20.8 (4.5-105.6) in group B (P <0.05). Blood transfused was 7.2 ml/kg per 24 h (0-29) in group A vs. 17.3 (3.1-49) in group B (P <0.05). Colloids transfused were 16.7 ml/kg per 24 h (0-64) in group A vs. 27.5 (0-58.6) in group B (P <0.05). No significant difference was found in urine output or the use of diuretics between the two groups. MUF results in better hemodynamic status in children, with the added advantage of less transfused blood and blood products. We believe that the use of accepted surgical techniques in combination with MUF will further improve the outcome of complex cardiac malformations.
由于大量水分积聚，儿童体外循环（CPB）的使用与显著的发病率相关。这可在体外循环期间通过大量利尿、腹膜透析或传统超滤技术（CUF）来降低。然而，我们对它们对我们年轻患者结局的影响不满意，最近开始使用改良超滤技术（MUF）并取得了良好效果。在CPB完成后进行15分钟的MUF，使血细胞比容达到40%。80例患者被平均分为两组——MUF组（A组）和对照组（B组）——并进行前瞻性研究。A组有1例死亡，B组有2例死亡。A组有1例患者胸部敞开，B组有3例患者胸部敞开。在MUF结束时，A组心脏尺寸较小，心脏功能较好，全身血压较高。两组在术前和CPB期间血细胞比容水平相似，但A组CPB后的血细胞比容显著更高，平均为39.4%（范围35 - 50），而B组为28.5%（范围22 - 38）（P <0.05）。A组每24小时失血量为10.56 ml/kg（2 - 48.7），B组为20.8 ml/kg（4.5 - 105.6）（P <0.05）。A组每24小时输血7.2 ml/kg（0 - 29），B组为17.3 ml/kg（3.1 - 49）（P <0.05）。A组每24小时输注胶体液16.7 ml/kg（0 - 64），B组为27.5 ml/kg（0 - 58.6）（P <0.05）。两组在尿量或利尿剂使用方面未发现显著差异。MUF可使儿童获得更好的血流动力学状态，还有减少输血和血液制品使用的额外优势。我们认为，采用公认的手术技术并结合MUF将进一步改善复杂心脏畸形的治疗效果。
