负平衡超滤联合改良超滤对瓣膜置换患者术后肺功能和早期认知功能的影响

发布时间：2018-03-30 19:31

本文选题：负平衡超滤　切入点：改良超滤　出处：《中国现代医学杂志》2015年14期

【摘要】：目的观察负平衡超滤联合改良超滤对瓣膜置换患者术后肺功能和早期认知功能的影响。方法 60例择期行二尖瓣置换术的患者分为常规超滤组(CUF组)和负平衡超滤+改良超滤组(S+M组),每组各30例。CUF组于复温后开始超滤,转流结束前停止超滤;S+M组转流开始10 min后行负平衡超滤,停机后行改良超滤。于转流前(T1)、转流结束即刻(T2)、术后2(T3)、12(T4)和24 h(T5)取动脉血标本,做血气分析并测定肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)的浓度;记录T1~T5各时间气道峰压(Peak)、呼吸停顿压(Ppause)、潮气量(TV)和吸入氧浓度(Fi O),计算肺静态顺应性(CLst)2、肺泡-动脉氧分压梯度(Aa DO2)及氧合指数(OI)。记录两组患者术中超滤量、清醒时间、呼吸机辅助呼吸时间。于麻醉前24 h、术后24、48和72 h时用简易精神状态量表(MMSE)测试患者的认知功能,记录术后72 h内术后认知功能障碍(POCD)的发生率。于转流前、超滤前及超滤后取动脉血,测定各时点患者血浆胶体渗透压(COP)及红细胞压积(Hct)。结果与T1相比,在T2~T5时两组患者CLst和OI均降低,Aa DO2、血浆内TNF-α及IL-6的浓度均升高;与CUF比较,在T2~T5时S+M组患者CLst和OI升高,Aa DO2、血浆内TNF-α及IL-6的浓度均降低,差异有统计学意义(P0.05);与CUF组比较,S+M组患者超滤量明显增多,术后患者的清醒时间、呼吸机辅助时间均减少,差异有统计学意义(P0.05);与术前24 h比较,两组患者术后24、48和72 h时的MMSE评分值均降低;与CUF组比较,S+M组患者术后48和72 h时MMSE评分值增加,术后72 h内POCD的发生率明显降低,差异有统计学意义(P0.05)。超滤后S+M组患者血浆COP和Hct与CUF组相比均明显升高;两组患者超滤前后血浆COP、Hct比较均明显升高,差异有统计学意义(P0.05)。结论术中使用负平衡超滤联合改良超滤可改善瓣膜置换患者术后肺功能和早期认知功能,有利于患者术后恢复。
[Abstract]:Objective to observe the effects of negative balance ultrafiltration combined with modified ultrafiltration on pulmonary function and early cognitive function after valve replacement.Methods Sixty patients undergoing elective mitral valve replacement were divided into conventional ultrafiltration group (CUF group) and negative balance ultrafiltration modified ultrafiltration group (S-M group).Before the end of bypass flow, the ultrafiltration of group S M was stopped 10 min after the start of the bypass, then negative balance ultrafiltration was performed, and then the modified ultrafiltration was performed after stopping.The arterial blood samples were collected before bypass, and the concentrations of tumor necrosis factor- 伪 (TNF- 伪) and interleukin-6 (IL-6) were measured.Peak airway pressure (Peak), respiratory standstill pressure (T1~T5), tidal volume (TTV) and inhaled oxygen concentration (T1~T5) were recorded at each time. The pulmonary static compliance and pulmonary alveola-artery oxygen pressure gradient (AaDO2) and oxygenation index (Oi) were calculated.Ultrafiltration, waking time and ventilator assisted breathing time were recorded in both groups.The cognitive function of the patients was measured by MMSE at 24 h before anesthesia, 24 h and 72 h postoperatively, and the incidence of cognitive dysfunction (POCD) was recorded within 72 h after operation.Arterial blood was taken before, before and after ultrafiltration. Plasma colloidal osmotic pressure (COP) and HCT were measured at different time points.The difference was statistically significant (P 0.05), compared with that in CUF group, the ultrafiltration volume in S M group was significantly increased, the waking time and ventilator assistant time were decreased, and the difference was statistically significant (P 0.05), compared with 24 hours before operation, there was no significant difference between the two groups.Compared with the CUF group, the MMSE score increased at 48 and 72 hours after operation, and the incidence of POCD decreased significantly at 72 hours after operation in both groups, and the difference was statistically significant (P 0.05).The levels of plasma COP and Hct in S M group after ultrafiltration were significantly higher than those in CUF group, and there was a significant difference between the two groups before and after ultrafiltration, and the difference was statistically significant (P 0.05).Conclusion negative balance ultrafiltration combined with modified ultrafiltration can improve pulmonary function and early cognitive function in patients with valvular replacement.
【作者单位】：广西医科大学第一附属医院心血管病研究所导管手术麻醉室;
【分类号】：R614

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