CVVH前后稀释对不同分子量溶质清除的影响

Efficiency of solutes clearances by pre - and post - dilution of CVVH

目的通过血液净化连续静脉一静脉血液滤过（CVVH）模式前、后稀释方法的体外试验，探讨前、后稀释对各种不同大小的溶质分子清除效率的影响。方法建立等容CVVH前、后稀释及CVVH单循环（无稀释）对照体外试验装置，比较不同分子量物质钾（K＋）、肌酐（Cr）、万古霉素（vancomycin）、胰岛素（insulin）和白细胞介素-6（IL-6）的清除率，实验重复4次（／Z=4）。结果CVVH后稀释法对K＋、Cr、万古霉素和胰岛素清除率明显高于前稀释；CVVH前、后稀释对IL-6清除无差别；对照组胰岛素和IL-6实验结束时明显降低。结论CVVH后稀释总体上对各种不同分子量物质清除率高于前稀释，但随着分子量的增大，两者间的差别缩小；对照组提示实验用滤器对胰岛素及IL-6有吸附作用。

Objective To compare the various solutes clearances by pre -dilution and post- dilution of continuous veno -venous haemofiltration （CVVH）. Methods An in vitro model CRRT system with AN69 filter was applied to perform CVVH. Solutes clearance of potassium ion （ K ~ ） , creatinine （Cr）, vancomycin, insulin and interleukin- 6 （IL- 6） were determined in the groups of control （without dilution）, pre - and post -dilution of CVVH with same substitution fluid components. Each group was repeated 4 times （ n = 4 ）. Results Post - dilution therapy increased K ~ , Cr, vancomycin and insulin clearance significantly. The clearance of IL - 6 showed no difference in the pre- and post - dilution groups. The control therapy made extremely decreased levels of insulin and IL - 6. Conclusion In general, post - dilution of CVVH can increase the clearance of various solutes. With molecular weight of the solutes increasing, the difference of clearance between pre - and post - dilution reduces. Data from the control group demonstrate that insulin and IL -6 can be adsorbed by the experimental filter.