血液透析联合血液灌流治疗中两种不同卸灌方式对治疗效果的影响

Influence of two different models of removing perfusion on therapeutic efficacy in patients with combination treatment of hemodialysis and hemoperfusion

目的探讨血液透析联合血液灌流治疗中2种不同卸灌方式对治疗效果的影响。方法肝素生理盐水冲洗浸泡灌流器,使灌流器中吸附剂充分膨胀肝素化,灌流器串联于透析器前端,联合治疗2.5h,卸下灌流器,再继续透析1.5h。20例患者每人3次血液透析联合血液灌流,其中10例30次生理盐水卸灌法,10例30次部分空气卸灌法。结果生理盐水卸灌法和部分空气卸灌法对中大分子毒素清除无影响(P>0.05),部分空气卸灌法的残血量大于生理盐水卸灌法(P<0.01),生理盐水卸灌法延续透析结束后透析器的凝血程度大于部分空气卸灌法(P<0.05)。结论 2种回血卸灌方式对中大分子毒素清除无影响;在减少失血量、杜绝空气栓塞、避免感染等方面,生理盐水卸灌法优于部分空气卸灌法。

Objective To explore the influence of two different different modelsof removing perfusion on therapeutic efficacy in patients with combination treatment of hemodialysis and hemoperfusion. Methods Perfusion apparatus was soaked and flushed by heparin and physiological saline in order to make adsorbents completely expand to heparinization.Perfusion apparatus was connected and cascaded to the front part of dialyzer. After implementation of combination treatment for 2.5hours, the perfusion apparatus was removed, and dialysis was continued for another 1.5 hours.There were three times of hemodialysis combined with hemoperfusion for each patient. 30 times of physiological saline removing method for perfusion apparatus were used in 10 patients, and 30 times of partial air removing method for perfusion apparatus were used in another 10 patients. Results There was no significant difference of removing of macromolecular toxins between physiological saline removing method and partial air removing method（P 0.05）. Residual blood amount with partial air removing method was more than that with physiological saline removing method（ P0.001）, and the coagulation degree of dialyzer with physiological saline removing method was significantly higher than that with partial air removing method（P 0.05）. Conclusion There is no significant difference of removing of macromolecular toxins between two different removing models for perfusion apparatus. Physiological saline removing method is significantly better than partial air removing method in the aspects of reducing blood loss, preventing air embolism and avoiding infections.