连续静脉血液滤过和血液滤过透析的实验研究

The experimental study of continuous venovenous hemofiltration and hemodiafiltration

目的 评价泵带动的连续静脉血液滤过 (CVVH)和连续静脉血液滤过透析 (CVVHDF)方法对高氮质血症动物模型的治疗效果和动物的耐受情况。方法 新西兰白兔 2 9只 ,麻醉后气管插管 ,接呼吸机 ,静脉注射尿素制成高氮质血症模型。比较CVVH时不同血流速度下的超滤率、CVVH组和CVVHDF组的尿素清除率 ,同时监测实验兔血液动力学及水电解质改变。结果 在血流速度为15、2 0、30、45ml/min时 ,超滤率分别为 (0 48± 0 0 7)、(0 6 1± 0 0 9)、(0 72± 0 0 6 )、(0 84± 0 0 8)ml/min ;尿素清除率分别为 (0 49± 0 0 6 )、(0 6 2± 0 0 8)、(0 74± 0 0 5 )、(0 86± 0 0 9)ml/min。超滤率和血流速度成线性回归关系 ,y =0 0 14x± 0 34 9(r=0 843,P <0 0 0 0 1)。血流速度为 (2 0 0± 0 6 )ml/min时 ,CVVH组的超滤率和尿素清除率分别为 (0 6 1± 0 0 6 )ml/min和 (0 6 3± 0 0 7)ml/min ;CVVHDF组的超滤率 +透析率和尿素清除率分别为 (17 5± 0 5 )ml/min和 (1 95± 0 31)ml/min ,后一项CVVHDF组是CVVH组的 3 1倍 (P <0 0 0 1)。两治疗组在治疗后 30、6 0、90、12 0、180min的尿素氮改变 ,差异有显著性 (P <0 0 5或P <0 0 1)。两治疗组分别与对照组相比 ,差异也有显著性 (P <0 0

Objective Continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodiafiltration (CVVHDF) are pump assisted continuous renal replacement treatments for acute renal failure and can be lasted for a longer time The pediatric patients, especially newborns and infants are sensitive to the minor changes of fluid and electrolytes Serious derangement in them may occur if CVVH or CVVHDF be used incorrectly The study here aimed to evaluate the efficiency and tolerance of CVVH and CVVHDF in the uremia animal model Methods The experiments were performed in 29 New Zealand anesthetized rabbits with ventilator and urea was infused The rabbits were divided into two groups after the operation In group 1 ( n =5), the ultrafiltrate flow rate (Q UF ) under different blood flow rates (Q B) and urea clearances (C urea ) in CVVH were determined In group 2, the 24 rabbits were divided into CVVH, CVVHDF and control groups The C urea was determined in treatment groups and urea removal in all groups The hemodynamic and electrolytes were monitored during the procedure Results In group 1, when Q B was at 15, 20, 30 and 45 ml/min in 5 rabbits, Q UF was (0 48±0 07), (0 61±0 09), (0 72±0 06) and (0 84±0 08) ml/min, and C urea was (0 49±0 06), (0 62±0 08), (0 74±0 05) and (0 86±0 09) ml/min, respectively There was a linear correlation between Q UF and Q B, y =0 014x±0 349 ( r =0 843, P <0 001) In group 2, when Q B was (20 0±0 6) ml/min in 24 rabbits, of which 22 were survival, the Q UF and C urea were (0 61±0 06 ) ml/min and (0 63±0 07) ml/min, respectively in CVVH ( n =8); the Q UF + Q D and C urea were (17 5±0 5) ml/min and (1 95±0 31) ml/min, respectively in CVVHDF ( n =7) The C urea in CVVHDF was 3 1 times as compared with that in CVVH There were significant differences in urea removal after 30, 60, 90, 120 and 180 min between CVVH and CVVHDF ( P <0 05 or <0 01) The urea removal also showed significant differences either between CVVH and control group ( n =7) or between CVVHDF and control group ( P <0 05 or <0 01), respectively By correcting the influence of hemodilution, the animals could keep the hemodynamic and electrolyte homeostasis Conclusion CVVH and CVVHDF benefited to the urea removal. CVVHDF presented with a higher C urea than CVVH With the same conditions, Q UF and C urea increased with the increase of Q B The experimental animals could tolerate to the maximum Q B and keep the balance of fluid and electrolyte during CVVH or CVVHDF under the careful prescription and monitoring