Effect Of Zero-balance Ultrafiltration On Human Renal Function After Cardiopulmonary Bypass

Objective:To explore the clinical significance of zero-balance ultrafiltration(Z-BUF)after extracorporeal circulation(ECC)in the protection of renal function in patients undergoing cardiac valve replacement.Methods:From June 2017 to January 2019,90 patients who underwent cardiac valve replacement in our department were randomly divided into three groups.The effects of ultrafiltration on renal function,lactic acid,hematocrit(HCT)and blood glucose in patients undergoing cardiac valve replacement were compared in the course of ECC.To evaluate the clinical effect of Z-BUF in cardiac surgery and its protective effect on renal function.Results:There were 90 patients,51 males and 39 females,aged between 30 and 75.Patients underwent mitral valve replacement(n = 43),aortic valve replacement(n =35)and double valve replacement(n = 12).Mitral valve replacement was performed in43 cases,aortic valve replacement in 35 cases,aortic valve replacement in 12 cases,including 1 case of aortic insufficiency with left atrial thrombosis,1 case of aortic stenosis with left atrium thrombus,1 case of aortic valve stenosis with left atrium thrombus,1 case of aortic valve insufficiency with left atrial thrombosis,1 case of aortic stenosis with left atrial thrombosis.Mitral regurgitation was associated with left atrial thrombosis in 4 cases,mitral stenosis with left atrial thrombosis in 6 cases,and old cerebral infarction in 1 case.There were 29 cases of atrial fibrillation and 1 case of premature ventricular fibrillation before operation.On admission,cardiac function was grade Ⅱ in 35 cases and grade Ⅲ in 55 cases.There was no significant difference in tumor necrosis factor-α(TNF-α)andinterleukin-6(IL-6)between T1 and T2.TNF-α showed that there was a significant increase in T3 in conventional ultrafiltration(CUF)group and A group,and there was no significant difference in T3 between CUF group and A group(P > 0.05),but there was no significant difference between T3 and T2.Group A reached the peak at T5 node,CUF group reached the peak at T6 node,CUF group and A group reached T3,T4,T5,while group A and group A reached peak at T5 node,T6 node,cuf group and A group at T3,T4,T5,respectively.There was significant difference in T6 between Z-BUF group and T6 group(P < 0 05).IL-6 showed that there was a significant increase in T3 in group A(P < 0 05),and there was a significant difference in group A(P < 0 05).There was a significant increase in T4 node in cuf group and significant difference in T3 between CUF group and Z-BUF group(P < 0.05).A vs CUF group and Z-BUF group,P < 0.05).CUF,P< 0.05).Group A and group A at T4,There was a significant difference in T5 and T6 between Z-BUF group and T5 and T6(P < 0.05).blood urine nitrogen(BUN),creatinine(Cr)showed no significant difference in T1,T2 and T3 among the three groups(P > 0 05).BUN,indicating that there was a significant increase in T4 in CUF group and A group,and there was no significant difference in T4 between CUF group and A group(P > 0 05).The difference was statistically significant between,CUF group and A group at T5,CUF group and A group at T4,T5 and T6 as compared with Z-BUF group(P < 0.05.There was significant difference between CUF group and A group T5,T5 and T6 in Z-BUF group).Cr showed that CUF group and A group began to increase significantly at T4,the difference was statistically significant(P < 0.05),CUF group and A group reached the peak at T4,CUF group and A group at T4(P < 0 05),T5,(P < 0 05).There was significant difference in T6 among three groups and T6 group(P < 0 05).There was no significant difference in HCT among the three groups at each time point(P > 0.05),but there was a significant difference in each group at the end of operation and before ECC(P < 0.05).There was no significant difference in lactic acid level before ECC.At the end of operation,the lactic acid level in CUF group and A group was significantly higher than that in Z-BUF group(P < 0.05),and there wasno significant difference in lactate level between the two groups at the end of operation(P < 0.05).However,the level of lactic acid decreased to the same level at24 hours after operation.There was no significant difference in blood glucose level between CUF group and A group as compared with Z-BUF group(P > 0 05),but there was a significant increase before ECC in the same group at the end of operation in the three groups(P < 0 05),but there was no significant difference in blood glucose level between the two groups(P < 0 05).Conclusion:This study found that cardiopulmonary bypass is non-physiological blood circulation,blood contact with the extracorporeal circulation machine pipeline,inflammatory mediators can not be effectively avoided at present,zero-balance ultrafiltration can reduce the levels of BUN,Cr and lactic acid in a certain extent.Zero-balance ultrafiltration has obvious advantages on the filtration of inflammatory mediators,and zero-balance ultrafiltration can improve the recovery of renal function in patients undergoing heart valve surgery,but the protective effect of Z-BUF alone may be limited.The effect of combined modified ultrafiltration may be better than that of using only one ultrafiltration method,and its effect needs further study.