| 方恒晓,范 悦,莫安胜,杨柳山,罗 磊,莫春镕.不同超滤方式对体外循环瓣膜置换术后患者心肺功能、补体和炎性介质的影响[J].,2023,(13):2494-2498 |
| 不同超滤方式对体外循环瓣膜置换术后患者心肺功能、补体和炎性介质的影响 |
| Effects of Different Ultrafiltration Methods on Cardiopulmonary Function, Complement and Inflammatory Mediators in Patients after Cardiopulmonary Bypass Valve Replacement |
| 投稿时间：2023-03-03 修订日期：2023-03-27 |
| DOI：10.13241/j.cnki.pmb.2023.13.018 |
| 中文关键词: 超滤方式 体外循环 瓣膜置换术 心功能 肺功能 补体 炎性介质 |
| 英文关键词: Ultrafiltration method Cardiopulmonary bypass Valve replacement Cardiac function Pulmonary function Complement Inflammatory mediators |
| 基金项目:国家自然科学基金项目（81860785） |
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| 中文摘要: |
| 摘要 目的：探讨不同超滤方式对体外循环（CPB）瓣膜置换术后患者心肺功能、补体和炎性介质的影响。方法：选择2018年1月~2022年6月于广西中医药大学附属瑞康医院接受CPB瓣膜置换术治疗的患者130例，应用随机数字表法将其分为常规超滤组（n=31）、改良超滤组（n=34）、零平衡超滤组（n=32）和联合组（改良超滤联合零平衡超滤）（n=33）。观察各组患者超滤前（T1）、超滤即刻（T2）、超滤后2 h（T3）、超滤后6 h（T4）心脏输出量（CO）、心脏指数（CI）、氧合指数（OI）、呼吸指数（RI）及肺静态顺应性（Cstat），并比较不同时间点各组患者血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、补体3a（C3a）、补体5a（C5a）水平。结果：T2、T3、T4时间点联合组CO和CI水平高于其他三组（P<0.05）。T2、T3、T4时间点联合组RI水平低于其他三组，OI和Cstat水平高于其他三组（P<0.05）。T2、T3、T4时间点联合组IL-6、C3a、C5a水平均低于其他三组，且TNF-α水平低于常规超滤组及改良超滤组（P<0.05）。结论：相对常规超滤、改良超滤、零平衡超滤，改良超滤联合零平衡超滤对CPB瓣膜置换术后患者心肺功能影响较小，术后炎症介质、补体水平升高程度较低，滤过效果明显，更适于CPB瓣膜置换术。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of different ultrafiltration methods on cardiopulmonary function, complement and inflammatory mediators in patients after cardiopulmonary bypass (CPB) valve replacement. Methods: 130 patients who were received CPB valve replacement in Ruikang Hospital affiliated to Guangxi University of Traditional Chinese Medicine from January 2018 to June 2022 were selected. They were randomly divided into conventional ultrafiltration group (n=31), modified ultrafiltration group (n=34), zero balance ultrafiltration group (n=32) and combined group (modified ultrafiltration combined with zero balance ultrafiltration) (n=33) according to the random number table method. The cardiac output (CO), cardiac index (CI), oxygenation index (OI), respiratory index (RI) and pulmonary static compliance (Cstat) of patients in each group before ultrafiltration (T1), immediately after ultrafiltration (T2), 2 h after ultrafiltration (T3), 6 h after ultrafiltration (T4) were observed. The levels of serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), complement 3a (C3a) and complement 5a (C5a) were compared in each group at different time points. Results: The CO and CI levels in the combined group at T2, T3 and T4 time points were higher than those in the other three groups(P<0.05). The RI level in the combined group at T2, T3 and T4 time points was lower than that in the other three groups, and the OI and Cstat levels were higher than those in the other three groups(P<0.05). The IL-6, C3a and C5a levels in the combined group at T2, T3 and T4 time points were lower than those in the other three groups, and TNF-α level was lower than that in the conventional ultrafiltration group and modified ultrafiltration group(P<0.05). Conclusion: Compared with conventional ultrafiltration, modified ultrafiltration and zero balance ultrafiltration, the modified ultrafiltration combined with zero balance ultrafiltration has less effect on cardiopulmonary function of patients after CPB valve replacement, and the level of inflammatory mediators and complements increased slightly after operation, so the filtering effect is obvious, and it is more suitable for CPB valve replacement. |
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