透析机自产回输液行血液滤过的临床分析

Clinical Study of Hemofiltration with on-line Production of Substitution Fluid

进一步研究透析机自产回输液行血液滤过(on-line)治疗方式对β_2-微球蛋白(β_2-MG)及小分子毒素的清除能力,以及它的稳定性及安全性,总结了近三年临床经验,并同血液透析进行自身比较.结果证实该方法清除β_2MG达31.58%,而同组病人作血液透析时,透析后血浓度较透前略有增加.前稀释血液滤过对BUN、肌酐的清除率及KT/V均低于血液透析组,分别是53.3%、57.7%及1.02/周;血液透析对BUN、肌酐清除率及Kv/V分别是68.9%、63.3%和1.34/周,P<0.05.血液滤过与血液透析时所用肝素量一样,不需增加剂量.血液滤过前后,病人收缩压、舒张压及体温均无显著性差异,无新出现的心律失常,心率于血液滤过后稍有降低,但在正常范围.这种治疗最好与血液透析交替进行.

The objective of this paper was to investigate the safety、stability and the ability of removing β2-MG and small molecule toxin of on-line hemofiltration treatment mode. All resultswere compared with routine hemodialysis. 10 male and 13 female patients with maintained hemodialysis for 3 months to 7 years received hemofiltration treatment in a predilution mode using on-line prepared infusion solution with Gambro UltraAK-100 once a week. None of the patients had any clinical complications needing hospitalization or special care during the study period. Systolic and diastolic blood pressures were stable. Heart rate was a little lower after treatment but ranged within the normal limits. No fever was observed during hemofiltration. The treatment was reliable and easy to handle and no side reaction was observed. Predilution hemofiltration offers the possibility to achieve a satisfactory treatment regarding middle weight solute clearance. The clearance of β2-MG reached 31. 8% in hemofiltration mode while the value of β2-MG was a little higher after hemodialysis. Predilution hemofiltration used the same amount heparin with routine dialysis and there was no viscosity problems. The clearance of BUN and Cr in predilution on-line hemofiltration was 53.3% and 57.7 % respectively while 68.9 % and 63.3 % in hemodialysis. KT/V was 1.02L/week in hemofiltration while 1.34L/week in hemodialysis, P<0.01. We concluded that on-line hemofiltration is better to be performed alternately with hemodialysis, such as hemofiltration is once a week, the other two times are hemodialysis.