CAJ | 학술논문

目的：探讨两种CRRT引血方法对血管活性药物依赖且持续CRRT治疗的重症患者更换CRRT管路和滤器时血流动力学的影响。方法回顾性调查2011年1月～2013年6月需要持续CRRT 治疗并使用血管活性药物去甲肾上腺素剂量＞0．1μg/（kg · min）的患者，使用方法一：当前治疗结束时，回血后按常规缓慢引血治疗（A组）；方法二：当前治疗结束时，按双机一引一回的引血治疗（B组），分析两组病人在CRRT 治疗开始时4 h血流动力学的变化。结果两组患者结束当前治疗到下一次引血治疗0 h、CRRT1 h的平均动脉压差异有显著意义（ P＜0．005）；两组患者结束当前治疗到下一次引血治疗0 h、CRRT 1 h、CRRT 2 h的去甲肾上腺素用量差异有显著意义（ P＜0．005）。结论对于严重血流动力学不稳定的患者在换管和滤器时采用双机操作，同时引血和回血的方法，能够保持病人生命体征平稳，减少治疗中断时间，更有利于患者安全。
목적：탐토량충CRRT인혈방법대혈관활성약물의뢰차지속CRRT치료적중증환자경환CRRT관로화려기시혈류동역학적영향。방법회고성조사2011년1월～2013년6월수요지속CRRT 치료병사용혈관활성약물거갑신상선소제량＞0．1μg/（kg · min）적환자，사용방법일：당전치료결속시，회혈후안상규완만인혈치료（A조）；방법이：당전치료결속시，안쌍궤일인일회적인혈치료（B조），분석량조병인재CRRT 치료개시시4 h혈류동역학적변화。결과량조환자결속당전치료도하일차인혈치료0 h、CRRT1 h적평균동맥압차이유현저의의（ P＜0．005）；량조환자결속당전치료도하일차인혈치료0 h、CRRT 1 h、CRRT 2 h적거갑신상선소용량차이유현저의의（ P＜0．005）。결론대우엄중혈류동역학불은정적환자재환관화려기시채용쌍궤조작，동시인혈화회혈적방법，능구보지병인생명체정평은，감소치료중단시간，경유리우환자안전。
Objective To investigate the hemodynamic effects between the two methods of CRRT beginning in vasopressor-dependent patients with replacement of CRRT circuits and the blood filters .Method Patients was sur-veyed retrospectively from January 2011 to June 2013 and requires constant CRRT treatment and use of vasoactive drugs noradrenaline dosage>0 .1 μg/(kg · min) .Using method 1:at the end of the current treatment ,according to conventional slower pump speed at start of CRRT (group A) and the method 2:at the end of the current treatment , using double machine operation to start blood pump and retune blood to the patient at the same time .(group B) , Hemodynamics changed between two groups of patients at the beginning of CRRT treatment for 4 hours was ana-lyzed .Result The mean arterial pressure for two groups of patients at the end of the current to the next beginning of CRRT 0 h ,CRRT 1h was significant different (P<0 .005);there was significant difference in norepinephrine dos-age for two groups of patients at the next end of the current blood lead therapeutic treatment 0h ,CRRT1h ,CRRT 2 h .Conclusion For patients with severe hemodynamic instability ,we can use double machine operation to start blood pump and retune blood at the same time during changing tube and filter .It is able to stabilize the patient's vital signs ,reduce the interruption of treatment time ,more conducive to patient safety .