中国急救复苏与灾害医学杂志
中國急救複囌與災害醫學雜誌
중국급구복소여재해의학잡지
CHINA JOURNAL OF EMERGENCY RESUSCITATION AND DISASTER MEDICINE
2015年
5期
453-455,459
,共4页
王廷海%付研%陈秀凯%姜雪
王廷海%付研%陳秀凱%薑雪
왕정해%부연%진수개%강설
持续性静-静脉血液滤过(CVVH)%普通肝素钠%浓度%滤器使用寿命
持續性靜-靜脈血液濾過(CVVH)%普通肝素鈉%濃度%濾器使用壽命
지속성정-정맥혈액려과(CVVH)%보통간소납%농도%려기사용수명
Continuous veno-venous hemofiltration (CVVH)%Unfractionated heparin sodium%Concentration%Usage time of filter
目的：比较两种不同浓度普通肝素钠全身抗凝方式在连续性肾脏替代治疗(CRRT)中的抗凝效果。方法选择需行持续性静-静脉血液滤过（CVVH）治疗且应用普通肝素钠全身抗凝的患者，给予首剂量25~30 IU/kg后，按普通肝素钠维持的给药浓度不同分为观察组（0.02%普通肝素钠溶液）和对照组（0.5%普通肝素钠溶液），进行自身交叉对照，两组普通肝素钠维持量5~10 IU/（kg·h）持续血液前泵泵入，开始4 h每小时检测一次活化部分凝血酶原时间（APTT），然后每4 h检测一次，来调节肝素的维持量。监测治疗过程单位时间普通肝素钠用量、凝血功能、跨膜压、滤器使用时间等指标。结果42例行CVVH治疗的患者入选，平均单位时间内观察组和对照组的普通肝素钠使用总剂量差异无统计学意义（t=0.512， P＞0.05），而滤器使用时间（实际治疗时间）分别为（19.2±1.6）h和（15.6±2.1）h，差异有统计学意义（t=2.410，P＜0.05）。结论CVVH治疗中不同浓度普通肝素钠全身抗凝，低浓度普通肝素钠抗凝明显延长滤器的使用寿命。
目的：比較兩種不同濃度普通肝素鈉全身抗凝方式在連續性腎髒替代治療(CRRT)中的抗凝效果。方法選擇需行持續性靜-靜脈血液濾過（CVVH）治療且應用普通肝素鈉全身抗凝的患者，給予首劑量25~30 IU/kg後，按普通肝素鈉維持的給藥濃度不同分為觀察組（0.02%普通肝素鈉溶液）和對照組（0.5%普通肝素鈉溶液），進行自身交扠對照，兩組普通肝素鈉維持量5~10 IU/（kg·h）持續血液前泵泵入，開始4 h每小時檢測一次活化部分凝血酶原時間（APTT），然後每4 h檢測一次，來調節肝素的維持量。鑑測治療過程單位時間普通肝素鈉用量、凝血功能、跨膜壓、濾器使用時間等指標。結果42例行CVVH治療的患者入選，平均單位時間內觀察組和對照組的普通肝素鈉使用總劑量差異無統計學意義（t=0.512， P＞0.05），而濾器使用時間（實際治療時間）分彆為（19.2±1.6）h和（15.6±2.1）h，差異有統計學意義（t=2.410，P＜0.05）。結論CVVH治療中不同濃度普通肝素鈉全身抗凝，低濃度普通肝素鈉抗凝明顯延長濾器的使用壽命。
목적：비교량충불동농도보통간소납전신항응방식재련속성신장체대치료(CRRT)중적항응효과。방법선택수행지속성정-정맥혈액려과（CVVH）치료차응용보통간소납전신항응적환자，급여수제량25~30 IU/kg후，안보통간소납유지적급약농도불동분위관찰조（0.02%보통간소납용액）화대조조（0.5%보통간소납용액），진행자신교차대조，량조보통간소납유지량5~10 IU/（kg·h）지속혈액전빙빙입，개시4 h매소시검측일차활화부분응혈매원시간（APTT），연후매4 h검측일차，래조절간소적유지량。감측치료과정단위시간보통간소납용량、응혈공능、과막압、려기사용시간등지표。결과42례행CVVH치료적환자입선，평균단위시간내관찰조화대조조적보통간소납사용총제량차이무통계학의의（t=0.512， P＞0.05），이려기사용시간（실제치료시간）분별위（19.2±1.6）h화（15.6±2.1）h，차이유통계학의의（t=2.410，P＜0.05）。결론CVVH치료중불동농도보통간소납전신항응，저농도보통간소납항응명현연장려기적사용수명。
Objective To compare the effects of two different concentration of unfractionated heparin sodium in systemic anticoagulant therapy on continuous renal replacement therapy. Methods 42 patients undergoing continuous veno-venous hemofiltration (CVVH) were given unfractionated heparin sodium solution at different concentration alternatively: 0.02% heparin sodium solution was given in the odd-numbered time (observation group) and 0.5% heparin sodium solution was given in the even-numbered time (control group). Then a self-crossover control trial was performed. ATTP was detected once every hour in the first 4 hours and then once every 4 hours so as to regulate the dose of heparin sodium to maintain the activated prothrombin time (APTT) level at 50~70 S. The values of APTT, prothrombin time (PT), and international normalized ratio (INR) before and after treatment, the transmembrane pressure (TMP) level during treatment, and the usage time of filter and treatment time were monitored. Results No significant difference in the total dosage of heparin sodium in unit time was found between the observation group and the control group (t=0.512, P>0.05). 4 and 8 hours after CVVH, the TMP values of the control group were both significantly higher than those of the observation group (both P<0.05). The general treatment and usage time of filter of the observation time were both significantly longer than those of the control group (both P<0.05]. Conclusion Low concentration of heparin can extend the filter’s lifetime in CVVH.
