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目的 比较不同超滤法在小儿体外循环中的效果。方法 80例先天性心脏病病儿 ,随机分成 4组 ,分别为对照 (CUF)组 ,平衡超滤 (BUF)组 ,改良超滤 (MUF)组和平衡超滤 +改良超滤 (B +M)组。在围术期检测肿瘤坏死因子 (TNF)、白细胞介素 8(IL 8)和E selectin的浓度。结果 CUF组各类炎症因子的浓度随转流时间的延长不断上升 ,BUF和B +M组停转流时炎症因子的浓度明显低于对照组和MUF组 (P <0 0 5 )。MUF组进行超滤时 ,炎症因子浓度上升 ,红细胞压积不断升高 ,B +M组在停体外循环时炎症介质浓度较低 ,但在改良超滤时上升 ,上升幅度较MUF组低。结论 平衡超滤法能降低体内炎症介质 ,改良超滤法可以在术后迅速浓缩血液 ,但不能降低炎症介质的浓度。平衡超滤和改良超滤结合起来应用 ,可兼有二者的作用 ,但仍不能在转流后将炎症介质的浓度保持在相当低的水平。
Objective To compare the effects of different ultrafiltration in pediatric cardiopulmonary bypass. Methods Eighty children with congenital heart disease were randomly divided into 4 groups: control (CUF) group, BUF group, MUF group, balanced ultrafiltration + modified ultrafiltration (B + M )group. Perioperative detection of tumor necrosis factor (TNF), interleukin 8 (IL 8) and E selectin concentrations. Results The concentrations of inflammatory cytokines in CUF group increased with the prolongation of time. The concentrations of inflammatory cytokines in BUF and B + M groups were significantly lower than those in control group and MUF group (P <0.05). In the MUF group, the concentration of inflammatory cytokines increased and the hematocrit increased continuously. In the B + M group, the concentration of inflammatory mediators was lower during the extracorporeal circulation, but increased in the modified ultrafiltration, which was lower than that in the MUF group. Conclusions Balanced ultrafiltration can reduce inflammatory mediators in vivo. Modified ultrafiltration can rapidly concentrate blood after surgery, but can not reduce the concentration of inflammatory mediators. Balanced ultrafiltration and modified ultrafiltration combined with the application of both can play the role, but still can not maintain the inflammatory mediator concentration is very low after the transfer.