中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2010年
11期
830-833
,共4页
唐新亚%任建安%顾国胜%陈军%樊跃平%黎介寿
唐新亞%任建安%顧國勝%陳軍%樊躍平%黎介壽
당신아%임건안%고국성%진군%번약평%려개수
危重病%肾功能衰竭%血液滤过%蛋白质丢失
危重病%腎功能衰竭%血液濾過%蛋白質丟失
위중병%신공능쇠갈%혈액려과%단백질주실
Critical illness%Kidney failure%Hemofiltration%Protein loss
目的 探讨危重患者连续静脉-静脉血液滤过治疗(CVVH)中滤液蛋白丢失及其主要影响因素.方法 对2008年9月至2009年9月收治的18例脓毒症或重症急性胰腺炎合并急性肾功能衰竭患者的临床资料进行分析.其中男性12例,女性6例,平均年龄45岁(39～62岁),均行24 h CVVH.置换液流速4000 mL/h,跨膜压(TMP)、血流量和超滤率分别为(173±48)mm Hg(1 mmHg=0.133 kPa)、(277±89)ml/h、(179±4)ml/min.采集滤前和滤后血液,连续收集24 h滤液,测定血浆和滤液总蛋白浓度,计算滤液蛋白丢失量并进行统计学分析.结果 滤液蛋白平均浓度(231±67)mg/L,滤液蛋白丢失量(22±6)g/d.CVVH治疗前后血浆蛋白水平差异无统计学意义[(56±6)g/L比(55±10)g/L,P＞0.05].滤液蛋白浓度和m浆蛋白平均浓度之间存在较弱相关性(r=0.481,P＜0.05),和TMP之间存在显著相关性(r=0.564,P＜0.01),多元逐步回归分析表明TMP和血浆蛋白浓度是影响滤液蛋白丢失的主要因素.结论 CVVH除了肾脏替代治疗作用外,也会引起血浆蛋白质经滤器丢失,其中,TMP和血浆蛋白浓度是影响滤液蛋白丢失的主要因素.在对接受CVVH治疗的危重患者制定营养方案时,必须考虑经滤器额外丢失的蛋白质.
目的 探討危重患者連續靜脈-靜脈血液濾過治療(CVVH)中濾液蛋白丟失及其主要影響因素.方法 對2008年9月至2009年9月收治的18例膿毒癥或重癥急性胰腺炎閤併急性腎功能衰竭患者的臨床資料進行分析.其中男性12例,女性6例,平均年齡45歲(39～62歲),均行24 h CVVH.置換液流速4000 mL/h,跨膜壓(TMP)、血流量和超濾率分彆為(173±48)mm Hg(1 mmHg=0.133 kPa)、(277±89)ml/h、(179±4)ml/min.採集濾前和濾後血液,連續收集24 h濾液,測定血漿和濾液總蛋白濃度,計算濾液蛋白丟失量併進行統計學分析.結果 濾液蛋白平均濃度(231±67)mg/L,濾液蛋白丟失量(22±6)g/d.CVVH治療前後血漿蛋白水平差異無統計學意義[(56±6)g/L比(55±10)g/L,P＞0.05].濾液蛋白濃度和m漿蛋白平均濃度之間存在較弱相關性(r=0.481,P＜0.05),和TMP之間存在顯著相關性(r=0.564,P＜0.01),多元逐步迴歸分析錶明TMP和血漿蛋白濃度是影響濾液蛋白丟失的主要因素.結論 CVVH除瞭腎髒替代治療作用外,也會引起血漿蛋白質經濾器丟失,其中,TMP和血漿蛋白濃度是影響濾液蛋白丟失的主要因素.在對接受CVVH治療的危重患者製定營養方案時,必鬚攷慮經濾器額外丟失的蛋白質.
목적 탐토위중환자련속정맥-정맥혈액려과치료(CVVH)중려액단백주실급기주요영향인소.방법 대2008년9월지2009년9월수치적18례농독증혹중증급성이선염합병급성신공능쇠갈환자적림상자료진행분석.기중남성12례,녀성6례,평균년령45세(39～62세),균행24 h CVVH.치환액류속4000 mL/h,과막압(TMP)、혈류량화초려솔분별위(173±48)mm Hg(1 mmHg=0.133 kPa)、(277±89)ml/h、(179±4)ml/min.채집려전화려후혈액,련속수집24 h려액,측정혈장화려액총단백농도,계산려액단백주실량병진행통계학분석.결과 려액단백평균농도(231±67)mg/L,려액단백주실량(22±6)g/d.CVVH치료전후혈장단백수평차이무통계학의의[(56±6)g/L비(55±10)g/L,P＞0.05].려액단백농도화m장단백평균농도지간존재교약상관성(r=0.481,P＜0.05),화TMP지간존재현저상관성(r=0.564,P＜0.01),다원축보회귀분석표명TMP화혈장단백농도시영향려액단백주실적주요인소.결론 CVVH제료신장체대치료작용외,야회인기혈장단백질경려기주실,기중,TMP화혈장단백농도시영향려액단백주실적주요인소.재대접수CVVH치료적위중환자제정영양방안시,필수고필경려기액외주실적단백질.
Objective To evaluate protein loss in critically ill patients with acute renal failure during continuous veno-venous hemofiltration(CVVH)and analysis the major factor impacting protein clearance.Methods A analysis was carried out iu eighteen(twelve male and six female)sepsis or severe acute panreatitis patients with acute renal failure from September 2008 to September 2009.The average age was 45 years(39-62 years).CVVH was conducted for 24 h in all patients.Effluent volume.blood speed,ultrafiltration rate and transmembrane pressure(TMP)were 4000 ml/h,(277±89)ml/h,(179±4)ml/min and(173±48)mm Hg(1 mm Hg=0.133 kPa)respectively.Blood samples were collected before and after filtration in order to detect protein concentration.Ultrailltrate was obtained hourly to measure protein concentration and calculate protein loss during session.Results Mean protein concentration was (231±67)mg/L and protein loss was(22±6)g/d in ultrafiltrate samples.The difference in serum protein level during hemofiltration was not significant[(56±6)g/L vs.(55±10)g/L,P＞0.05],while there was a weak.but statistically significant correlation between the uhrafiltrate protein concentration and the corresponding value for serum protein(r=0.481,P＜0.05).However,there was a strong and statistically significant correlation between the ultrafiltrate protein concentration and the TMP(r=0.564.P＜0.01).Stepwise multiple regression analysis showed that TMP and serum protein concentration played a pivotal role in ultrafiltrate protein loss.Conclusions In addition to renal replacement therapy.serum protein would be cleared through hemofilter during CVVH.TMP and serum protein concentration are the main factors that affect protein loss in ultrafiltrate.As a result.it is necessary to take account of the protein legg in uhrafiltrate when setting nutritional schedule.
