CAJ | 학술논문

目的探讨局部柠檬酸抗凝(RCA)对连续性静脉-静脉血液滤过(CVVH)治疗滤器使用时间的影响分析.方法选择急性肾功能不全采用CVVH治疗的患者25例,完全随机分成研究组(柠檬酸抗凝,14例)和对照组(低分子肝素抗凝,11例).观察指标:①第一套滤器使用时间；②CVVH治疗前及治疗4h、更换滤器时游离Ca2浓度；③CVVH前后患者血气分析:pH、Na+、HCO3-、碱剩余.结果 ①CVVH治疗4h时研究组游离Ca2+浓度明显低于治疗前[(0.52±0.19)mmol/L比(0.99±0.04)mmol/L,P＜0.05],更换滤器时与CVVH治疗前比较无明显改变(P＞0.05).对照组CVVH治疗4h、更换滤器时与CVVH治疗前的差异均无统计学意义(均P＞0.05).CVVH治疗4h时,研究组与对照组游离Ca2+浓度的差异有统计学意义[(0.52±0.19) mmol/L比(0.99 ±0.09) mmol/L,P＜0.05].②研究组和对照组滤器使用时间分别为(34±5)和(13±3)h,差异有统计学意义(P＜0.05).③治疗后,2组Na+、HCO3-和碱剩余恢复正常水平,与治疗前比较差异均有统计学意义(均P ＜0.05),研究组治疗后与对照组的差异均无统计学意义(均P＞0.05).结论 RCA可明显延长CVVH滤器使用时间,改善因频繁更换滤器对治疗效果的影响.
목적 탐토국부저몽산항응(RCA)대련속성정맥-정맥혈액려과(CVVH)치료려기사용시간적영향분석.방법 선택급성신공능불전채용CVVH치료적환자25례,완전수궤분성연구조(저몽산항응,14례)화대조조(저분자간소항응,11례).관찰지표:①제일투려기사용시간；②CVVH치료전급치료4h、경환려기시유리Ca2농도；③CVVH전후환자혈기분석:pH、Na+、HCO3-、감잉여.결과 ①CVVH치료4h시연구조유리Ca2+농도명현저우치료전[(0.52±0.19)mmol/L비(0.99±0.04)mmol/L,P＜0.05],경환려기시여CVVH치료전비교무명현개변(P＞0.05).대조조CVVH치료4h、경환려기시여CVVH치료전적차이균무통계학의의(균P＞0.05).CVVH치료4h시,연구조여대조조유리Ca2+농도적차이유통계학의의[(0.52±0.19) mmol/L비(0.99 ±0.09) mmol/L,P＜0.05].②연구조화대조조려기사용시간분별위(34±5)화(13±3)h,차이유통계학의의(P＜0.05).③치료후,2조Na+、HCO3-화감잉여회복정상수평,여치료전비교차이균유통계학의의(균P ＜0.05),연구조치료후여대조조적차이균무통계학의의(균P＞0.05).결론 RCA가명현연장CVVH려기사용시간,개선인빈번경환려기대치료효과적영향.
Objective To observe the effect of usage time of hemofiltration filter in continuous venous-venous hemofiltration (CVVH) by the regional citrate anticogulation.Methods Totally 25 patients with acute kidney injury(AKI) were selected and randomly divided into theray group [regional citrate anticoagulation (RCA) group (14 cases)] and control group [low molecular weight heparin group (11 cases)].We recorded the usage time of the first set of hemofiltration filter and the concentration of the free calcium (iCa2 +) before CVVH,4 h post-CVVH,and the time for the replacement hemofiltration filter.We also measured the arterial blood gas of patients before and after CVVH.Results ① iCa2+ concentration in theray group were decreased at 4 h-post CVVH compared with before CVVH [(0.52 ± 0.19) mmol/L vs (0.99 ± 0.04) mmol/L,P ＜ 0.05].But the change of the iCa2 + concentration in control group was not significant at 4 h-post CVVH than before CVVH.The change of iCa2+ concentration at the theray group compared with control group was significant different at 4 h-post CVVH [(0.52 ±0.19) mmol/L vs (0.99 ±0.09)mmoL/L,P ＜0.05].②The usage time of hemofiltration filter were prolonged in the theray group compared with low molecular weight control group [(34 ±5) vs (13 ±3)h,P ＜0.05].③The change of the serum sodium(Na+),base excess (BE) and bicarbonate HCO3-at the two groups were significantly different after CVVH than before CVVH.Conclusions RCA can extend the usage time of hemofiltration filter,and improve patient outcomes.