A prospective randomized study of a modified technique of ultrafiltration during pediatric open-heart surgery.
A prospective randomized study of a modified technique of ultrafiltration during pediatric open-heart surgery.
复制标题
儿科心脏直视手术中超滤改良技术的前瞻性随机研究。
作者：
Naik Sk;A. Knight;MJ Elliott
常规超滤（UF）不能令人满意地逆转血液稀释和体外循环（CPB）后全身水（TBW）的升高。我们修改了在CPB回路中使用UF的技术、时间和位置，并在初步研究中观察到血细胞比容的可控升高和TBW的显著降低。我们对50名接受心脏直视手术的儿童进行了一项前瞻性随机研究，比较改良UF （MUF）和非过滤对照。CPB完成后10分钟进行MUF，红细胞压积36-42。术后24小时记录体液平衡、TBW（生物阻抗法）和血流动力学。采用Mann-Whitney U检验对结果进行分析，将对照（n = 24）与超滤（n = 24）进行比较。每组有一人死亡。对照组失血量（ml/kg/24小时）中位数为19.5（范围9-30），而MUF组为12.5 (8-22)(p = 0.0002)；输血量（ml/kg/24小时）：对照组15.5 (3-35)，MUF组3 (0-11)(p = 0.0001)；胶体输注量（ml/kg/24小时）在对照组为12(6-56)，在MUF组为12 (0-28)(p = 0.18)；对照组TBW升高11.1%(4.3-16.8)，而MUF组TBW升高4.0 (1.6-7.9)（p = 0.0001）。在MUF期间动脉血压升高。对照组收缩压升高百分比为1(-4至+9)，而MUF组收缩压升高百分比为49 (5-81)(p = 0.0001)；对照组舒张压升高0(-5至+8)，而MUF组舒张压升高28 (3-47)（p = 0.0001）。用友降低了与CPB相关的儿童TBW和供血需求的升高。在UF期间观察到的血压升高尚未得到解释，但如果被证明是安全的，该技术可能允许无供体血液的心脏手术，并防止潜在危险的过量组织液的积累。
Conventional ultrafiltration (UF) fails to reverse satisfactorily hemodilution and the rise in total body water (TBW) seen after cardiopulmonary bypass (CPB). We have modified the technique, timing, and placement of UF in the CPB circuit and in pilot studies observed controlled elevation of hematocrit and a significantly reduced rise in TBW. We have carried out a prospective randomized study in 50 children undergoing open-heart surgery, comparing modified UF (MUF) with nonfiltered controls. MUF was carried out for 10 minutes after completion of CPB to a hematocrit of 36-42. Fluid balance, TBW (by bioimpedance), and hemodynamics were recorded for 24 hours postoperatively. The results were analyzed using Mann-Whitney U test, comparing controls (n = 24) to ultrafiltered (n = 24). There was one death in each group. Blood loss (ml/kg/24 hr) was 19.5 median (range, 9-30) in the controls versus 12.5 (8-22) in MUF (p = 0.0002); blood transfused (ml/kg/24 hr) 15.5 (3-35) in controls versus 3 (0-11) in MUF (p = 0.0001); colloid transfused (ml/kg/24 hr) 12 (6-56) in controls versus 12 (0-28) in MUF (p = 0.18); percent rise in TBW 11.1 (4.3-16.8) in controls versus 4.0 (1.6-7.9) in MUF (p = 0.0001). There was rise in arterial blood pressure during MUF. Percent rise of systolic blood pressure was 1 (-4 to +9) in controls versus 49 (5-81) in MUF (p = 0.0001); percent rise in diastolic blood pressure 0 (-5 to +8) in controls versus 28 (3-47) in MUF (p = 0.0001). UF reduced the rise in TBW and donor blood requirement associated with CPB in children. The blood pressure rise observed during UF is as yet unexplained, but if proven safe the technique may permit donor blood-free cardiac surgery and prevent the accumulation of potentially dangerous excess tissue fluid.