The Effect Of Zero-balanced Ultrafiltration And Modified Ultrafiltration On Pulmonary Function In Pediatric Open Heart Surgery

Objective: To study The effect of zero-balanced ultrafiltration and modified ultrafiltration on pneodynamic parameters and some inflammatory mediators in children underging open heart surgery.Method: 60 cases with congenital heart disease were divided into control group (C), modified ultrafiltration group (M) and balanced ultrafiltration with modified ultrafiltration group (U). In the C group, the cardiopulmonary bypass (CPB) was used without ultrafiltration, while in the other two groups additional modified ultrafiltration and balanced ultrafiltration with modified ultrafiltration was used separately. The blood gas, peak pressure, pause pressure, tidal volume, frequency, fraction of inspired oxygen, inspiration time, the serum level of the interleukin-6 and interleukin-8 were measured in before CPB(T1), 20 minutes after CPB(T2), 2 hours after operation(T3), 6 hours after operation(T4) and 12 hours after operation(T5) separately.Results: 1) Three groups' static pulmonary compliance(C_stat), peak airway pressure(Ppeak), alveolar-arterial oxygen difference(AaDO₂), oxygen index(OI) and the level of IL-6, IL-8 were changed dramatically after CPB. 2) At T3, T4, T5 times, the M group's C_stat was higher and the R_aw was lower compared with C group; the M group's AaDO₂ was lower and OI was higher compared with C group. 3) The U group's C_stat was higher and the R_aw was lower compared with M group and C group at T5 time. At T4, T5 times, the U group's AaDO₂ was lower and OI was higher compared with M group and C group. 4) In the U group, the level of IL-6 and IL-8 were lower compared with M group and C group at T2, T3, T4, T5 times, but there is no difference between C group and M group.Conclusion: 1 )The pediatric's pulmonary ventilation and gas exchange function were decreased and the serum level of inflammatory mediators were increases. 2) Modified ultrafiltration can produce an immediate improvement in pulmonary ventilation and gas exchange. 3) Modified ultrafiltration can't decrease the level of inflammatory mediator while balanced ultrafiltration can. 4) Combined balanced ultrafiltration with modified ultrafiltration can produce an immediate improvement in pulmonary ventilation and gas exchange, exclude inflammatory mediators, and attenuate inflammatory responsive pulmonary injury.Significance: Zero-balanced ultrafiltration and modified ultrafiltration were used in pediatric open heart surgery. The result of combining the merits of them not only improves pulmonary ventilation and air exchange but also exclude inflammatory mediators, so it can produce a better of pulmonary function. We provide a new direction of the choices of the ultrafiltration methods in pediatric open heart surgery.