Koutlas T C, Gaynor J W, Nicolson S C, Steven J M, Wernovsky G, Spray T L
Department of Anesthesiology, Children's Hospital of Philadelphia, PA 19104, USA.
Ann Thorac Surg. 1997 Jul;64(1):37-42; discussion 43. doi: 10.1016/s0003-4975(97)00505-5.
Modified ultrafiltration reduces the deleterious effects of cardiopulmonary bypass in children. Patients undergoing repair of single-ventricle cardiac anomalies may be particularly sensitive to these adverse effects, and benefit from the use of modified ultrafiltration.
From January 1995 to June 1996, 120 consecutive cavopulmonary operations were performed at The Children's Hospital of Philadelphia. Procedures included lateral tunnel fenestrated Fontan (n = 50), extracardiac Fontan (n = 5), hemi-Fontan (n = 60), and bidirectional Glenn shunt (n = 5). Modified ultrafiltration was performed after cardiopulmonary bypass in 41 patients, and results were compared by t test with a control group of 79 patients in whom modified ultrafiltration was not used.
There was one death for an operative (30-day) mortality of 0.8%. Age, weight, diagnosis, ischemic arrest time, and cardiopulmonary bypass time were similar between the modified ultrafiltration and control groups. Postoperative blood use, chest tube output, the incidence of pleural and pericardial effusions, and hospital stay were all significantly decreased when modified ultrafiltration was used.
By lowering the perioperative morbidity of staged cavopulmonary operations, modified ultrafiltration makes an important contribution to improving outcome after the correction of single-ventricle cardiac anomalies.
改良超滤可减轻儿童体外循环的有害影响。接受单心室心脏畸形修复的患者可能对这些不良反应特别敏感，并受益于改良超滤的使用。
1995年1月至1996年6月，费城儿童医院连续进行了120例腔肺手术。手术包括侧隧道开窗Fontan术（n = 50）、心外Fontan术（n = 5）、半Fontan术（n = 60）和双向Glenn分流术（n = 5）。41例患者在体外循环后进行了改良超滤，并将结果与未使用改良超滤的79例患者对照组进行t检验比较。
有1例死亡，手术（30天）死亡率为0.8%。改良超滤组和对照组在年龄、体重、诊断、缺血停搏时间和体外循环时间方面相似。使用改良超滤后，术后输血量、胸管引流量、胸腔和心包积液的发生率以及住院时间均显著降低。
改良超滤通过降低分期腔肺手术的围手术期发病率，为改善单心室心脏畸形矫正后的预后做出了重要贡献。
