不同连续性肾脏替代治疗模式溶质清除和体外循环通路抗凝效果的比较

摘要

Objective To compare the effects of three modes [continuous veno venous hemofiltration (CVVH),continuous veno venous hemodialysis (CVVHD) and continuous veno venous hemofiltration (CVVHDF)] of continuous renal replacement therapy (CRRT) on solute clearance and anticoagulant efficiency on extracorporeal circulation pathway.Methods A total of 49 patients who received CRRT in our hospital from March to October in 2017 were selected.They received CVVH,CVVHD and CVVHDF three modes respectively.The patients were given the same treatment dose,blood volume,anticoagulation way and dosage of anticoagulant.The clearance rate of creatinine,urea,uric acid,phosphorus and beta 2 microglobulin in three different treatment modes was compared.At the same time,the coagulations of the extracorporeal circulation pathway during the treatment were monitored.Results At the same therapeutic dose,the solute clearance rate of serum creatinine,urea,uric acid and phosphorus in CVVHDF and CVVHD was significantly higher than in CVVH (P＜0.01).The solute clearance rate of beta 2 microglobulin in CVVHDF and CVVH was significantly higher than in CVVHD (P＜0.01).Under the same anticoagulant method and the dosage of anticoagulant,the coagulations of the extracorporeal circulation in the CVVHDF mode were significantly superior to those in CVVH and CVVHD (P＜0.05).Conclusions The clearance rate of CVVHDF and CVVHD for small solutes was higher than that of CVVH,while the clearance rates of CVVHDF and CVVH to macromolecules solutes were higher than those of CVVHD.Under the same anticoagulation way and the dosage of anticoagulants,the anticoagulant efficiency of CVVHDF on extracorporeal circulation was more satisfactory than CVVH and CVVHD.Therefore,it is suggested that CVVHDF may be the first choice in CRRT.%目的 比较连续性静脉静脉血液滤过(CVVH)、连续性静脉-静脉血液透析(CVVHD)及连续性静脉-静脉血液透析滤过(CVVHDF)3种不同的连续性肾脏替代治疗模式对溶质的清除效率以及体外循环通路抗凝的效果.方法 选取2017年3月至2017年10月在武汉市第五医院行连续性肾脏替代治疗的患者49例,分别接受CVVH、CVVHD及CVVHDF 3种模式治疗,同一患者CRRT治疗剂量、血流量、抗凝方式及抗凝剂用量相同.比较3种不同治疗模式对血肌酐、尿素氮、尿酸、血磷、β2微球蛋白的清除率,同时监测治疗过程中体外循环通路凝血的情况.结果 在相同CRRT治疗剂量下,CVVHDF、CVVHD对血肌酐、尿素氮、尿酸、血磷的清除率高于CVVH,且有统计学差异(P＜0.01);CVVH-DF、CVVH对β2微球蛋白的清除率高于CVVHD,且有统计学差异(P＜0.01).在抗凝剂方式及抗凝剂用量相同的情况下,选取CVVHDF治疗模式体外循环通路凝血情况好于CV-VH及CVVHD治疗模式,且有统计学差异(P＜0.05).结论 CVVHDF、CVVHD对小分子溶质的清除率高于CVVH,而CVVHDF和CVVH对中大分子溶质的清除率高于CVVHD;在抗凝方式相同及抗凝剂用量相同的情况下,CVVHDF对体外循环通路的抗凝效果好于CV-VH及CVVHD.因此,建议临床上行连续性肾脏替代治疗时可首选CVVHDF模式.