平衡超滤技术对小儿先心病术后炎症因子、凝血功能及肺功能的影响

目的:探讨平衡超滤技术对小儿先心病术后炎症因子、凝血功能及肺功能的影响。方法:选择2014年9月至2017年9月我院接诊的100例先天性心脏病患儿进行研究,通过随机数表法分为观察组55例和对照组45例,两组均于体外循环下实施心内直视手术,观察组在体外循环启动后患儿复温时开始平衡超滤,并于体外循环结束后即刻进行改良超滤,对照组仅在体外循环结束后即刻进行改良超滤。比较两组不同时间点炎症因子、凝血功能及肺功能的变化、术后恢复情况及并发症。结果:于体外循环结束后(术后)20 min(T1)、术后2 h(T2)、术后6 h(T3)各时点,观察组血清肿瘤坏死因子(TNF)-α、白介素(IL)-6、IL-10均明显比对照组低(P<0.05);观察组各时点活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)均明显低于对照组(P<0.05);观察组各时点肺静脉顺应性(Cstat)、氧合指数(OI)在各时点均明显高于对照组,肺泡-动脉氧分压梯度(AaDO2)明显低于对照组(P<0.05);观察组血管活性药使用时间、呼吸机使用时间和ICU住院时间均明显比对照组短(P<0.05),观察组感染、弥散性血管性凝血、肺功能损伤等发生率明显低于对照组(P<0.05)。结论:在改良超滤技术上,联合平衡超滤更有助于减轻小儿先心病术后炎症因子的释放,具有较好的凝血功能、肺功能保护作用,可有效促进术后恢复,减少围术期并发症。

Effects of Balanced Ultrafiltration on Inflammatory Factors, Coagulation Function and Lung Function in Children with Congenital Heart Disease after Operation

Objective:To study the effects of balanced ultrafiltration on the inflammatory factors,coagulation function and lung function in children with congenital heart disease after operation.Methods:100 children with congenital heart disease who were treated from September 2014 to September 2017 in our hospital were selected as the research objects,they were divided into the observation group(55 cases)and the control group(45 cases)by random number table method,they underwent open heart surgery under cardiopulmonary bypass,the observation group began to balance ultrafiltration after rewarming after cardiopulmonary bypass,and underwent modified ultrafiltration was performed immediately after cardiopulmonary bypass,the control group only underwent modified ultrafiltration immediately at the end of cardiopulmonary bypass.The changes of inflammatory factors,coagulation function and lung function at different time points,postoperative recovery and incidence of complications were compared between the two groups.Results:At 20 min(T1),2h(T2)and 6h(T3)after cardiopulmonary bypass(postoperation),the serum tumor necrosis factor(TNF)-α,interleukins(IL)-6,IL-10,activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB)and alveolar-arterial oxygen partial pressure gradient(AaDO2)in the observation group were significantly lower than those in the control group(P<0.05),the pulmonary venous compliance(Cstat)and oxygenation index(OI)were significantly higher than those in the control group,and the time of using vasoactive drugs,ventilator and ICU hospitalization were significantly shorter than those in the control group(P<0.05).Compared with the control group,the incidence of infection,disseminated vascular coagulation and pulmonary function were significantly decreased(P<0.05).Conclusion:On the basis of modified ultrafiltration technology,the combination of balanced ultrafiltration is more helpful to reduce the release of inflammatory factors in children with congenital heart disease,and improve coagulation and pulmonary function,promote THE postoperative recovery with higher safety.