持续高容量血液滤过治疗挤压综合征影响肌红蛋白清除效率的因素分析

Analysis of the factors affecting myoglobin clearance in treatment of crush syndrome by high volume continuous hemofiltration

目的探讨持续高容量血液滤过治疗过程中影响肌红蛋白清除效果的因素。方法以汶川地震中出现挤压综合征伴有急性肾功能衰竭的3例伤员作为研究对象,均行高容量连续性静脉-静脉血液滤过治疗,应用正交设计的方法,以肌红蛋白的实际筛选系数作为评价指标,选取血流量、滤器型号和治疗时间作为研究因素,每个因素分为3个水平:血流量分别为180、220、250ml/min,滤器型号为APF10S、HF1200、AV600,治疗时间为1、4、8h,计算不同血流量、滤器型号和治疗时间条件下滤器肌红蛋白的筛选系数,比较上述因素对滤器的肌红蛋白筛选系数的影响。结果不同治疗时间的肌红蛋白筛选系数有明显差异(P=0.028),随着治疗时间的延长,滤器的肌红蛋白筛选系数明显下降。不同型号滤器对肌红蛋白的筛选系数没有影响(P=0.427),不同血流量对肌红蛋白的筛选系数也没有影响(P=0.117)。结论治疗时间是影响肌红蛋白清除效果的主要因素,定期更换滤器可以提高持续静脉-静脉血液滤过对肌红蛋白的清除效率。

Objective To explore the factors affecting myoglobin clearance in the treatment of crush syndrome with high volume continuous hemofiltration. Methods High volume continuous venous-venous hemofiltration was performed in 3 patients with crush syndrome-induced acute renal failure as a result of Wenchuan earthquake in China. Orthogonal design was applied in present study for taking the actual screening coefficient of myoglohin as the evaluation criterion, and the blood flow, type of filter and therapy time were the factors studied. Each factor was designed in three levels： blood flow including 180, 220 and 250 ml/min; type of filter including APF-10S, HF1200 and AV600; therapy time including 1, 4 and 8 hours. The screening coefficients of filter myoglobin were calculated and compared according to the conditions of different blood flow, types of filter and treatment time. Results There were significant differences between the screening coefficients of myoglobin with different treatment time （P= 0. 028）. And the screening coefficients of filter myoglobin declined with the increase of treatment time. The screening coefficients of filter myoglobin were affected by neither types of filter （P=0. 427） nor blood flow （P=0. 117）. Conclusions The results of present study have demonstrated that therapy time is the main factor affecting myoglohin elearanee during high volume continuous venous-venous hernofiltration, and that regular change of filters may enhance myoglobin clearance during continuous venous-venous hemofiltration.