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目的探讨比较改良超滤与常规超滤技术在婴幼儿先天性心脏病心内直视手术体外循环中的应用,以指导临床选择。方法选取2007年1月~2010年11月,无肝肾功能不全及其他合并症行先天性心脏病心内直视手术患儿40例,随机分为超滤组(CUF组)20例,改良超滤(MUF)20例。分别统计比较转流前、转流结束和停机超滤结束后抽取动脉血测定血红细胞压积(Hct),术后24h胸腔引流量,呼吸机的使用时间,术后输血量。结果所有病例无死亡,均顺利出院,术后未发现与超滤及体外循环有关的并发症。转流前的红细胞压积2组间差异无显著性(P>0.05);转流中由于两组均有一定程度的血液稀释,Hct下降,但是MUF组仍高于CUF组(P<0.05);停机超滤结束后MUF组亦高于CUF组(P<0.05),MUF组输入库血量、胸腔24h引流量、呼吸机辅助时间都明显低于CUF组(P<0.05)。结论改良超滤能较快排除体内水分,减少术后输血并缩短拔管时间,有利于改善患儿愈后。
Objective To compare the application of modified ultrafiltration and conventional ultrafiltration in cardiopulmonary bypass of open heart surgery in infants with congenital heart disease to guide clinical choice. Methods From January 2007 to November 2010, 40 children undergoing open heart surgery without congenital heart failure and other comorbidities were randomly divided into two groups: ultrafiltration group (CUF group) Filter (MUF) in 20 cases. The arterial blood samples were taken for determination of hematocrit (Hct), postoperative thoracic drainage volume, duration of ventilator use, and postoperative blood transfusion. Results No deaths were found in all cases and all patients were discharged smoothly. No complications related to ultrafiltration and cardiopulmonary bypass were found after operation. There was no significant difference between the two groups before hemodialysis (P> 0.05). In both groups, there was a certain degree of hemodilution and decreased Hct, but MUF was still higher than that of CUF (P <0.05) (P <0.05). In the MUF group, the input blood volume in the MUF group, the amount of drainage in the thoracic cavity in 24h and the ventilatory assist time in the MUF group were significantly lower than those in the CUF group (P <0.05). Conclusion Modified ultrafiltration can quickly remove the body of water, reduce postoperative blood transfusion and shorten the extubation time, help to improve the prognosis of children.