血液保存液在连续性血液滤过中的应用

Application of acid citrate dextrose in contiunous veno-venous hemofiltration

目的评价血液保存液用于连续性血液滤过(CVVH)治疗的效果和安全性。方法77例有出血倾向的重症患者行CVVH治疗,分为局部肝素抗凝组(A组,31例)和局部枸橼酸葡萄糖(ACD)抗凝组(B组,46例)。B组用ACD作抗凝剂,维持滤器后离子钙(iCa2+)0.25-0.35mmol/L。比较两组滤器的寿命、抗凝效果和不良反应,并进行经济学评价。结果 A组滤器使用寿命短于B组[(17.3±1.4)h vs.(41.5±4.6)h](P<0.01)。两组治疗前后凝血酶原时间、活化部分凝血酶时间无明显变化;但A组治疗后血小板水平明显下降[(130.50±58.20)×109/L vs.(111.10±45.40)×109/L](P<0.01)。B组平均输血量、每日治疗成本明显少于A组[(7.4±2.3)ml/h vs.(23.4±4.8)ml/h、(3371±249)元vs.(4334±1107)元](P<0.05或P<0.01)。B组有13例次并发代谢性碱中毒,降低置换液中碳酸氢钠至28mmol/L后碱中毒获纠正。结论 CVVH治疗中,ACD抗凝方案安全、有效、经济,易于临床推广。调整置换液碳酸氢钠浓度可有效避免代谢性碱中毒的发生。

Objective To assess the effectiveness and safety of acid citrate dextrose （ACD） solution in contiunous veno-venous hemofiltration（CVVH）. Methods A total of 77 patients with bleeding risk was divided into two groups of A（treated with regional heparin anticoagulation, 31 cases） and B（treated with regional ACD anticoagulation, 46 cases）. ACD was taken as anticoagulant to maintenance post-filter ionized calcium（iCa2＋） 0. 25-0. 35 mmol/L. The dialyzer lifespan, anticoagulation effectiveness,adverse effects and costs were compared. Results The mean dialyzer lifespan in group A was shorter than that in group B[（17. 3±1. 4） h vs. （41.5±4. 6） hi （P〈0. 01）. Compared with before, the prothrombin time and activated partial thromboplastin time were not obvioulsy changed after treatment in groups of A and B, but platelet count was decreased in group A[ （130.50±58. 20） ）×10^9/L vs. （111.10±45.40）×10^9/L]（P〈0. 01）. The amount of blood transfusion and cost in group B were less than those in group At（7. 4±2.3） ml/h vs. （23.4±4. 8） ml/h and （3371±249） RMB vs. （4334±1107） RMB] （P〈0. 05 or P〈0. 01）. The metabolic alkalosis occurred in 13 cases of group B, which was corrected by decreasing the concentration of sodium bicarbonate to 28 mmol/L in the hemofiltration solution. Conclusion ACD anticoagulation in CVVH treatment is safe, effective, cheap and easy for clinical application. Metabolic alkalosis can be prevented by adjusting the concentration of sodium bicarbonate in replacement solution.