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已发表论文
零平衡超滤可减少体外循环心脏手术后的术后谵妄：一项随机对照试验
Authors Lan X, Tang S, Lu J, Tang G, Shao Y, Zhu Z , Zhou K, Xiong X, Chen D, Shi J
Received 25 September 2025
Accepted for publication 11 December 2025
Published 23 December 2025 Volume 2025:21 Pages 1807—1819
DOI https://doi.org/10.2147/TCRM.S570006
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Sandeep Ajoy Saha
Xin Lan,1,2,* Sijie Tang,1,* Jun Lu,1 Guangling Tang,1 Yi Shao,1 Zhenyan Zhu,1 Kun Zhou,1 Xinglong Xiong,1 Dongxu Chen,3,4,* Jing Shi1,*
1Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China; 2Department of Anesthesiology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, People’s Republic of China; 3Department of Anesthesiology, West China Second Hospital, Chengdu, People’s Republic of China; 4Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jing Shi, Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China, Tel +86-18685034016, Email shijing81@gmc.edu.cn Dongxu Chen, Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, People’s Republic of China, Tel +86-15881730901, Email scucdx@foxmail.com
Purpose: To assess the effects of conventional ultrafiltration and conventional plus zero-balanced ultrafiltration on delirium and cognition in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Methods: A total of 116 adults who were scheduled for cardiac surgery with CPB were randomly assigned to the conventional ultrafiltration group or the conventional plus zero-balanced ultrafiltration group. CPB was managed with standard protocols. In the conventional ultrafiltration group, ultrafiltration began during the rewarming phase and was performed until the CPB was terminated. In another group, perfusionists conducted zero-balance ultrafiltration after aortic cross-clamping and began conventional ultrafiltration during the rewarming phase. The primary outcome was the incidence of postoperative delirium (POD) within 7 days; the secondary outcome was postoperative cognitive dysfunction (POCD) at 1 and 3 months. In addition, the patients’ vital signs and postoperative complications at different points during the operation were also recorded.
Results: During the first 7 postoperative days, POD was observed in 12 patients in the zero-balance ultrafiltration group and 27 patients in the conventional ultrafiltration group (12/53 [22.64%] vs 27/53 [50.94%]; RR 0.45, 95% CI 0.25 to 0.78; P = 0.005). At 1 month after surgery, POCD occurred in 12 patients in the zero-balance ultrafiltration group versus 18 patients in the conventional ultrafiltration group (12/53 [22.64%] vs 18/53 [33.96%]; RR = 0.67; 95% CI 0.36– 1.24; P = 0.281). By 3 months postoperatively, postoperative cognitive dysfunction occurred in 4 patients in the zero-balance ultrafiltration group and 7 patients in the conventional ultrafiltration group (4/53 [7.55%] vs 7/53 [13.21%]; RR = 0.57; 95% CI 0.18– 1.84; P = 0.524).
Conclusion: In patients who underwent cardiac surgery with CPB, zero-balance ultrafiltration significantly reduced the incidence of delirium compared with conventional ultrafiltration alone within the first 7 postoperative days. In contrast, the incidence of cognitive dysfunction did not differ significantly between the two groups at 1 or 3 months postoperatively.
Keywords: ultrafiltration, cardiopulmonary bypass, cardiac surgery, delirium, cognitive function
1Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China; 2Department of Anesthesiology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, People’s Republic of China; 3Department of Anesthesiology, West China Second Hospital, Chengdu, People’s Republic of China; 4Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jing Shi, Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China, Tel +86-18685034016, Email shijing81@gmc.edu.cn Dongxu Chen, Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, People’s Republic of China, Tel +86-15881730901, Email scucdx@foxmail.com
Purpose: To assess the effects of conventional ultrafiltration and conventional plus zero-balanced ultrafiltration on delirium and cognition in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Methods: A total of 116 adults who were scheduled for cardiac surgery with CPB were randomly assigned to the conventional ultrafiltration group or the conventional plus zero-balanced ultrafiltration group. CPB was managed with standard protocols. In the conventional ultrafiltration group, ultrafiltration began during the rewarming phase and was performed until the CPB was terminated. In another group, perfusionists conducted zero-balance ultrafiltration after aortic cross-clamping and began conventional ultrafiltration during the rewarming phase. The primary outcome was the incidence of postoperative delirium (POD) within 7 days; the secondary outcome was postoperative cognitive dysfunction (POCD) at 1 and 3 months. In addition, the patients’ vital signs and postoperative complications at different points during the operation were also recorded.
Results: During the first 7 postoperative days, POD was observed in 12 patients in the zero-balance ultrafiltration group and 27 patients in the conventional ultrafiltration group (12/53 [22.64%] vs 27/53 [50.94%]; RR 0.45, 95% CI 0.25 to 0.78; P = 0.005). At 1 month after surgery, POCD occurred in 12 patients in the zero-balance ultrafiltration group versus 18 patients in the conventional ultrafiltration group (12/53 [22.64%] vs 18/53 [33.96%]; RR = 0.67; 95% CI 0.36– 1.24; P = 0.281). By 3 months postoperatively, postoperative cognitive dysfunction occurred in 4 patients in the zero-balance ultrafiltration group and 7 patients in the conventional ultrafiltration group (4/53 [7.55%] vs 7/53 [13.21%]; RR = 0.57; 95% CI 0.18– 1.84; P = 0.524).
Conclusion: In patients who underwent cardiac surgery with CPB, zero-balance ultrafiltration significantly reduced the incidence of delirium compared with conventional ultrafiltration alone within the first 7 postoperative days. In contrast, the incidence of cognitive dysfunction did not differ significantly between the two groups at 1 or 3 months postoperatively.
Keywords: ultrafiltration, cardiopulmonary bypass, cardiac surgery, delirium, cognitive function