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目的比较10～20kg先天性心脏病患儿用不同预充液预充对胶体渗透压的影响,以及胶体渗透压的改变与肺功能的关系。方法40例10～20kg体重先天性心脏病患儿随机分为4组:A组:血浆预充组(对照组);B组:血浆预充加超滤组;C组:血定安预充组;D组:血定安加超滤组。观察体外循环期间胶体渗透压的变化及记录体外循环转流前后肺功能变化的指标[包括血气分析结果计算出来的呼吸指数(RI)、氧合指数(OI);肺动态顺应性(Cdyn)、气道阻力(Raw)、气道峰压(Peak)],并比较各组转中、转后12h尿量和拔管时间。结果A、B两组体外循环转流中胶体渗透压值均明显下降(P<0.05),A组停机时胶体渗透压仍处于较低水平直到体外循环转流1h后才恢复到转流前水平,而B组超滤后胶体渗透压值显著升高并且转流5h后仍高于转流前水平(P<0.05);C组在整个实验期间胶体渗透压值均没有显著改变;D组体外循环转流期间胶体渗透压值与转流前水平保持一致,但超滤后明显上升直到转流后5h也没有恢复到转前水平(P<0.05)。同时观察到C组的RI和OI在整个实验期间没有显著变化,并且转流后12h尿量比其他3组明显增多,拔管时间较其他3组显著缩短(P<0.05);其他3组在转机后1h均有RI的明显升高和OI的明显下降。A组COP下降与RI升高的百分比无直线相关(r=0.115,P>0.05);与OI降低的百分比无直线相关(r=0.350,P>0.05)。B组COP下降与RI升高的百分比无直线相关(t=0.039,P>0.05);与OI降低的百分比无直线相关(r=0.127,P>0.05)。结论体外循环中预充血定安能够维持胶体渗透压在体外循环过程中的不改变,且对于体外循环各项指标有改善。
Objective To compare the effect of pre-filling with different pre-filling on the colloid osmotic pressure and the relationship between colloid osmotic pressure and pulmonary function in 10 ~ 20kg children with congenital heart disease. Methods Forty infants with congenital heart disease of 10 ~ 20kg body weight were randomly divided into 4 groups: group A: plasma pre-charge group (control group); group B: plasma prefilled ultrafiltration group; group C: ; D group: Xueding Anga ultrafiltration group. To observe changes of colloid osmotic pressure during cardiopulmonary bypass and to record changes of pulmonary function before and after cardiopulmonary bypass (including respiratory index (RI) and oxygenation index (OI) calculated from blood gas analysis results; lung dynamic compliance (Cdyn) Raw, airway peak pressure], and compared the urine output and extubation time of 12 h after mid-transfer and post-transfer. Results The colloid osmotic pressure of A and B groups were significantly decreased (P <0.05), while the colloid osmotic pressure of group A was still low at 1h after CPB, and returned to the pre-flow level , But the colloid osmotic pressure increased significantly after ultrafiltration in group B and was still higher than that before the transfer (P <0.05) after 5h, while the colloid osmotic pressure did not change significantly in group C during the whole experiment. In group D Colloid osmotic pressure during cyclic flow was consistent with that before flow, but it increased obviously after ultrafiltration, and did not return to pre-flow 5 h after flow-through (P <0.05). At the same time, it was observed that there was no significant change of RI and OI in C group during the whole experiment, and the amount of urine in 12 hours after the transfer was significantly increased compared with the other three groups, and the extubation time was significantly shorter than the other three groups (P <0.05) 1h after the transfer were significantly increased RI and OI decreased significantly. There was no linear correlation between the decline of COP and the percentage of RI in group A (r = 0.115, P> 0.05), but not linearly with the percentage of OI reduction (r = 0.350, P> 0.05). There was no linear correlation between the decrease of COP and the percentage of RI in group B (t = 0.039, P> 0.05), but not linearly with the percentage of OI reduction (r = 0.127, P> 0.05). Conclusion Precontusion and stability during cardiopulmonary bypass can maintain the colloid osmotic pressure unchanged during cardiopulmonary bypass, and improve the indexes of cardiopulmonary bypass.