中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (12): 2277-2280.doi: 10.3969/j.issn.1673-8225.2010.12.047

• 生物材料临床实践 clinical practice of biomaterials • 上一篇    

国产聚砜膜透析器应用于心脏体外循环手术中的可能性

陈茄克1，刘  华2，朱  越○3，周志明4，杨  谦1，杨益民5   

  1. 1厦门大学附属中山医院心外科，福建省厦门市  361004；2中南大学湘雅三医院卫生部移植医学工程技术研究中心，湖南省长沙市  410013；3美国匹兹堡大学器官移植研究院，200 Lothrop Street C-700, Pittsburgh, PA 15213, USA；4中南大学湘雅三医院麻醉科，湖南省长沙市  410013；5中南大学湘雅三医院，湖南省长沙市  410013
  • 出版日期:2010-03-19 发布日期:2010-03-19
  • 作者简介:陈茄克，女，1970年生，福建省厦门市人，汉族，1990年福建医科大学毕业，主管技师，主要从事体外循环心肌保护的研究。
  • 基金资助:

    国家211工程项目，No. 1998-6。

Possibility of domestically produced polysulfone dialyser for extracorporeal circulation during cardiac surgery

Chen Jia-ke1, Liu Hua2, Zhu Yue○3, Zhou Zhi-ming4, Yang Qian1, Yang Yi-min5   

  1. 1 Department of Cardiac Surgery, Zhongshan Hospital, Xiamen University, Xiamen  361004, Fujian Province, China; 2 Transplantation Medicine Engineering Research Center of State Ministry of Health, Third Xiangya Hospital, Central South University, Changsha   410013, Hunan Province, China; 3 Organ Transplantation Institute, University of Pittsburgh, 200 Lothrop Street C-700, Pittsburgh, PA 15213, USA
    4 Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha   410013, Hunan Province, China
    5 Third Xiangya Hospital, Central South University, Changsha   410013, Hunan Province, China
  • Online:2010-03-19 Published:2010-03-19
  • About author:Chen Jia-ke, Technician in charge, Department of Cardiac Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361004, Fujian Province, China chen_prc@126.com
  • Supported by:

    A Grant from the National 211 Engineering Project Foundation, No.1998-6*

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摘要：

背景：进口人工肾价钱昂贵，且存在设计方面的不足，如在滤除水分的同时也丢失了各种中小分子如电解质及葡萄糖等。
目的：探讨国产人工肾-聚砜膜透析器应用于心脏体外循环手术的可能性。
方法：选择的17例患者中瓣膜置换术9例，冠脉搭桥5例，法乐氏四联症2例, 右窒双出口1例。于常规的体外循环受过程中，在体外循环动脉端安装微栓过滤器，其顶端三通出口分别连接泵压表、聚砜膜透析器入血口和经硅胶管接贮血瓶与氧合器相连，通过调节动脉泵的流量确保动脉压和中心静脉压。以常规体外循环中使用过滤器联合利尿合剂治疗18例为对照。体外循环前后按常规计算预冲液量，并与麻醉师共同维持患者体外循环前后平均动脉压、中心静脉压的稳定。观察体外循环前后患者电解质、葡萄糖及渗透压的变化。
结果与结论：聚砜膜透析器在体外循环手术中滤水作用十分明显，效果明显优于对照组，肾透析液中的电解质、尿素氮、葡萄糖和渗透压与使用人工肾前血液中的值无显著差别。提示国产聚砜膜透析器能够代替超滤器应用于体外循环手术中，且效果更理想，为术后心功能恢复和防止其他并发症的发生有良好作用，为一些重症心功能不全、转流时间长、婴幼儿、液体进入体内多而排出尿少等患者提供了另一条出路。

关键词: 聚砜膜透析器, 国产人工肾, 体外循环, 心脏手术

Abstract:

BACKGROUND: The imported artificial kidney costs much and has design deficiency, for example, various kinds of middle or small-sized molecules, such as electrolytes and glucose, are missing while filtering the water out.
OBJECTIVE: To investigate the possibility of domestically produced artificial kidney for extracorporeal circulation during cardiac surgery.
METHODS: A total of 17 patients were included, comprising 9 patients subjected to valve replacement, 5 undergoing coronary artery bypass, 2 suffering from fallot's tetralogy, and 1 with double outlet right ventricle. The arterial end of the extracorporeal circulation was provided with a microthrombus filter, with a T joint on its top with one of the ports connected with a pressure gauge, one connected with the blood inlet of the hemodialyzer, and one (the blood outlet) connected with the inlet of a blood container, which led the blood into an oxygenator. The arterial pressure and central venous pressure were maintained by regulating the flow rate of pressure gauge. Eighteen patients who received treatment using filter in conjunction with diuretic agent served as controls. Prior to and after extracorporeal circulation, cardioplegic solution was calculated, and the mean arterial pressure and central venous pressure were maintained. In addition, changes in electrolytes, glucose, and osmotic concentration were also monitored prior to and after extracorporeal circulation.
RESULTS AND CONCLUSION: During cardiac surgery with extracorporeal circulation, polysulfone dialyser showed a significant water filtration. No significant difference was observed between prior to and after use of artificial kidney in terms of electrolyte, urea nitrogen, glucose, and osmotic pressure. These findings indicate that domestically produced artificial kidney polysulfone dialyser can substitute hyperfiltration apparatus to be applied to extracorporeal circulation with more benefits, which positively affect postoperative recovery of cardiac function, prevent from other complications, and provide another prospect for some patients with sever cardiac dysfunction or prolonged extracorporeal circulation, infant patients, or patients with higher liquid intake but lower urine volume.

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