本文選題：負(fù)平衡超濾　切入點(diǎn)：改良超濾　出處：《中國(guó)現(xiàn)代醫(yī)學(xué)雜志》2015年14期

【摘要】：目的觀察負(fù)平衡超濾聯(lián)合改良超濾對(duì)瓣膜置換患者術(shù)后肺功能和早期認(rèn)知功能的影響。方法 60例擇期行二尖瓣置換術(shù)的患者分為常規(guī)超濾組(CUF組)和負(fù)平衡超濾+改良超濾組(S+M組),每組各30例。CUF組于復(fù)溫后開始超濾,轉(zhuǎn)流結(jié)束前停止超濾;S+M組轉(zhuǎn)流開始10 min后行負(fù)平衡超濾,停機(jī)后行改良超濾。于轉(zhuǎn)流前(T1)、轉(zhuǎn)流結(jié)束即刻(T2)、術(shù)后2(T3)、12(T4)和24 h(T5)取動(dòng)脈血標(biāo)本,做血?dú)夥治霾y(cè)定腫瘤壞死因子-α(TNF-α)及白細(xì)胞介素-6(IL-6)的濃度;記錄T1~T5各時(shí)間氣道峰壓(Peak)、呼吸停頓壓(Ppause)、潮氣量(TV)和吸入氧濃度(Fi O),計(jì)算肺靜態(tài)順應(yīng)性(CLst)2、肺泡-動(dòng)脈氧分壓梯度(Aa DO2)及氧合指數(shù)(OI)。記錄兩組患者術(shù)中超濾量、清醒時(shí)間、呼吸機(jī)輔助呼吸時(shí)間。于麻醉前24 h、術(shù)后24、48和72 h時(shí)用簡(jiǎn)易精神狀態(tài)量表(MMSE)測(cè)試患者的認(rèn)知功能,記錄術(shù)后72 h內(nèi)術(shù)后認(rèn)知功能障礙(POCD)的發(fā)生率。于轉(zhuǎn)流前、超濾前及超濾后取動(dòng)脈血,測(cè)定各時(shí)點(diǎn)患者血漿膠體滲透壓(COP)及紅細(xì)胞壓積(Hct)。結(jié)果與T1相比,在T2~T5時(shí)兩組患者CLst和OI均降低,Aa DO2、血漿內(nèi)TNF-α及IL-6的濃度均升高;與CUF比較,在T2~T5時(shí)S+M組患者CLst和OI升高,Aa DO2、血漿內(nèi)TNF-α及IL-6的濃度均降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);與CUF組比較,S+M組患者超濾量明顯增多,術(shù)后患者的清醒時(shí)間、呼吸機(jī)輔助時(shí)間均減少,差異有統(tǒng)計(jì)學(xué)意義(P0.05);與術(shù)前24 h比較,兩組患者術(shù)后24、48和72 h時(shí)的MMSE評(píng)分值均降低;與CUF組比較,S+M組患者術(shù)后48和72 h時(shí)MMSE評(píng)分值增加,術(shù)后72 h內(nèi)POCD的發(fā)生率明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。超濾后S+M組患者血漿COP和Hct與CUF組相比均明顯升高;兩組患者超濾前后血漿COP、Hct比較均明顯升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論術(shù)中使用負(fù)平衡超濾聯(lián)合改良超濾可改善瓣膜置換患者術(shù)后肺功能和早期認(rèn)知功能,有利于患者術(shù)后恢復(fù)。
[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- 偽 (TNF- 偽) 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.
【作者單位】： 廣西醫(yī)科大學(xué)第一附屬醫(yī)院心血管病研究所導(dǎo)管手術(shù)麻醉室;
【分類號(hào)】：R614

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 凡小慶;王瑞婷;;細(xì)胞因子與體外循環(huán)肺損傷的研究進(jìn)展[J];臨床肺科雜志;2014年05期

2 趙志勇;高永謙;閻志軍;馮光興;何榮海;趙硯麗;李建立;于新江;;中性粒細(xì)胞黏附分子表達(dá)及細(xì)胞因子釋放在體外循環(huán)炎性反應(yīng)中的作用[J];中國(guó)全科醫(yī)學(xué);2008年22期

3 張濤;李佳春;王加利;丁振元;駱?biāo)|;馬蘭;;負(fù)平衡超濾在心臟瓣膜置換術(shù)體外循環(huán)中的應(yīng)用[J];中國(guó)體外循環(huán)雜志;2008年03期

4 陳萍;雷迪斯;章曉華;陳寄梅;莊建;;微小化體外循環(huán)管路減少新生兒及小嬰兒術(shù)中用血及炎性反應(yīng)[J];中國(guó)體外循環(huán)雜志;2010年03期

5 王濤;張青;沈定榮;陳子民;;去白細(xì)胞血預(yù)充對(duì)嬰兒體外循環(huán)肺保護(hù)作用的研究[J];中國(guó)體外循環(huán)雜志;2009年02期

【共引文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王彥隆;房瑞芹;;心臟瓣膜置換手術(shù)的體外循環(huán)管理分析探討[J];當(dāng)代醫(yī)學(xué);2011年17期

2 肖蒼松;王嶸;李伯君;吳揚(yáng);王剛;任崇雷;葉衛(wèi)華;盛煒;李佳春;王加利;陳婷婷;周琪;張濤;馬蘭;高長(zhǎng)青;;急診冠狀動(dòng)脈搭橋救治急性冠狀動(dòng)脈綜合征及中期隨訪[J];南方醫(yī)科大學(xué)學(xué)報(bào);2014年05期

3 王佳;丁佑銘;;持續(xù)血液凈化治療急性重癥胰腺炎的療效及機(jī)制研究[J];安徽醫(yī)藥;2014年09期

4 楊曉剛;郭德和;邊虹;何進(jìn)喜;;體外循環(huán)期間細(xì)胞因子TNF-α、IL-6與中性粒細(xì)胞的變化及其相互影響[J];南京醫(yī)科大學(xué)學(xué)報(bào)(自然科學(xué)版);2009年11期

5 王加利;高長(zhǎng)青;李佳春;張濤;馬蘭;;負(fù)壓輔助靜脈引流技術(shù)在全機(jī)器人心臟手術(shù)中的應(yīng)用[J];軍醫(yī)進(jìn)修學(xué)院學(xué)報(bào);2012年11期

6 王興鵬;李兆申;袁耀宗;杜奕奇;曾悅;;中國(guó)急性胰腺炎診治指南(2013年,上海)[J];臨床肝膽病雜志;2013年09期

7 楊新軍;吳廣禮;;連續(xù)性血液凈化對(duì)多器官功能障礙綜合征患者免疫狀態(tài)的調(diào)節(jié)[J];臨床誤診誤治;2014年05期

8 朱建峰;陳學(xué)梅;袁e，

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