连续性肾脏替代治疗机器HF400临床应用的评价

Experience with application of HF400:a recently developed machine for continuous renal replecement therapy

目的 :观察一种连续性肾脏替代治疗 (CRRT)机器HF4 0 0临床使用效果 ,及其对容量控制的精确度。 方法 :解放军肾脏病研究所 2 4例住院患者 ,因急性肾功能不全 (ARF)或合并心衰、水肿需行CRRT治疗 ,采用HF4 0 0机器、AV6 0 0s行连续性静脉 静脉血液滤过 (CVVH)治疗 ,置换液流量 3～ 4L/h ,治疗时间 6～ 8h ,观察治疗前、后患者血清尿素氮 (BUN)、肌酐 (SCr)、尿酸 (UA)及血清电解质钾、钠、氯的变化 ,比较设定治疗剂量与实际治疗剂量 ,设定净超滤量与实际净超滤量的差值。 结果 :2 4例患者完成治疗。治疗后BUN、SCr及Ua下降率分别为 (42± 11) %、(41± 12 ) %及 (5 6± 8) % ,血清钾、钠及氯水平无显著变化。设定治疗量为 (2 8 6± 3 7)L ,而实际治疗量为(2 7 8± 3 4 )L ,相差 2 5 % (中位数 ,95 %范围 0 6 %～ 7 2 % )。设定净超滤量为 (2 74 8± 96 9)ml,实际净超滤量为(2 5 5 4± 819)ml,相差 5 4 % (中位数 ,95 %范围 1 9%～ 13 6 % )。总的容量误差率为 0 5 2 % (中位数 ,95 %范围0 12 %～ 1 0 % )。 结论 :HF4 0 0机器能安全有效用于临床患者的救治 ,容量控制精确度较高。

Objective:In this report, we described our experience with the application of a recently developed machine for continuous renal replacement therapy(CRRT). Methodology:Twenty-four patients in the clinical ward of the institute were enrolled in this study. All of the patients were indicated for the application of CRRT, with the clinical development of acute renal failure(ARF) or chronic renal failure(CRF) complicated with heart failure or lung edema. Continuous veno-venous hemofiltration(CVVH) was performed in these patients using HF400 CRRT machine and AV600s filters. The flow rate of substitute fluid was 3-4L/h, duration of each session of CRRT lasted for 6-8 hours. Before and after each session of CVVH, serum level of urea, creatinine, uric acid, and electrolytes such as potassium, sodium and chloride were evaluated. Prescribed treatment dose, net ultrafiltration volume, and delivered treatment dose, delivered net ultrafiltration volume were recorded. Results:All the patients tolerated CVVH therapy well. Reduction rate of serum urea, creatinine, uric acid after CVVH were (42±11)%,(41±12)% and (56±8)%, respectively. Serum electrolytes levels were maintained in stable range. The percentage of difference between prescribed dose(28.6±3.7L) and delivered dose(27.8±3.4L) was 2.5%(median,95% range 0.6%-7.2%). The percentage of difference between prescribed net ultrafiltration volume( 2 748±969 ml) and delivered net ultrafiltration volume[( 2 554±819) ml] was 5.4%(median, 95% range 1.9%-13.6%). The deviation rate of total volume control was 0.52%( median,95% range 0.12%-1.0%). Conclusion:This new model of HF400 for CRRT is safe and effective, with excellent accuracy of volume control in clinical applications.