Effect of Modified Ultrafiltration on Pediatric Open Heart Surgery

소아 개심술시 변형 초여과법(Modified Ultrafiltration)의 효과

  • 윤경찬 (계명대학교 의과대학 흉부외과학교실) ;
  • 이광숙 (계명대학교 의과대학 흉부외과학교실) ;
  • 유영선 (계명대학교 의과대학 흉부외과학교실) ;
  • 박창권 (계명대학교 의과대학 흉부외과학교실) ;
  • 최세영 (계명대학교 의과대학 흉부외과학교실) ;
  • 최대융 (계명대학교 의과대학 흉부외과학교실)
  • Published : 1998.01.01

Abstract

Total body water is increased after cardiopulmonary bypass resulting in tissue edema and organ dysfunction. Ultrafiltration has been used to reduce this accumulation of water. We have carried out a prospective randomized study in 17 children undergoing open heart surgery, comparing modified ultrafiltration(MUF) with nonfiltered controls. MUF was carried out for about 10 minutes after completion of cardiopulmonary bypass to a hematocrit 36∼42%. Blood loss, blood transfused, hemodynamics, and laboratory data were recorded for 24 hours postoperatively. The results were analyzed using Mann-Whitney U test, comparing controls(n=7) to ultrafiltered(n=10). There was no death in each group. The mean filtrate volume(ml/kg) was 42(30∼68). Blood loss(ml/kg/24hr) was 14.5 mean(4.0∼26.6) in controls versus 12.1 mean(6.0∼21.5) in MUF(P>0.05) ; blood transfused(ml/kg/24hr) was 9.4 mean (6.0∼36.3) in controls versus 3.4 mean(0∼11.4) in MUF(P<0.05). There was rise in arterial blood pressure during MUF. Percent rise of systolic blood pressure was 4.2(0∼11.7) in controls versus 19.8(7.0∼36.9) in MUF(P=0.001). Percent rise of diastolic blood pressure was 10.0(1.6∼20.8) in controls versus 30.6(5.8∼73.3) in MUF(P<0.05). Platelet count, fibrinogen, and oncotic pressure rose after MUF. No complications directly attributable to the ultrafiltration were observed. Conclusively, MUF is safe, effective means of removing body water and beneficial to hemodynamics.

체외순환을 이용한 개심술후 과도한 체내 수분 축적은 중요 장기의 기능 이상을 초래한다. 본 논문에서는 소아 개심술시 변형 초여과법을 적용하여 적절한 수분제거와 심폐기능에 미치는 효과를 관찰하기위하여 개심술을 받은 17례의 환자를 대상으로 변형 초여과를 시행한 초여과군 10례와 대조군 7례로 나누어 그 효과를 비교 분석하였다. 초여과군에서 초여과의 시행은 체외순환 완료직후부터 평균 9.8분 시행하여 매 환아당 평균 42ml/kg의 수액을 여과시켜 초여과 실시후 평균 헤마토크리트가 41.7%로 증가함을 관찰할 수 있었다. 초여과군에서는 변형 초여과를 시행하기전에 비해 수축기 및 이완기혈압의 증가가 대조군에 비해 유의하게 높았다. 또한, 대조군에 비해 초여과군에서 혈소판등의 혈액응고인자의 보존효과도 높았으며 변형 초여과법 시행에 따른 합병증은 없었다. 이상의 결과에서 소아 개심술시 변형 초여과법의 적용은 혈역학적 및 혈액학적 이득을 보여 심폐기능의 향상과 환자의 회복에 기여하는 방법이라 사료되어진다.

Keywords

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