血液灌流联合连续性肾脏替代治疗不同待机模式对滤器使用时间的影响

THE IMPACT ON SERVICE TIME OF FILTER SYSTEM UNDER TWO DIFFERENT STANDBY MODES WHEN HEMOFILTRATION COMBINED WITH CONTINUOUS RENAL REPLACEMENT

目的探讨在连续性肾脏替代治疗(CRRT)联合血液灌流(HP)治疗且不能串联时,血滤机二种不同待机模式对滤器使用时间的影响。方法将50例妊娠合并高脂血症性胰腺炎的患者随机分为改良组和对照组,行CRRT6h后改行HP一次,并以原血滤配套继续CRRT治疗,灌流期间血滤机回血后干预组进入暂停模式,对照组以肝素预冲液接于动脉端,静脉端接无菌引流袋,使血滤机低效运转。统计分析二组患者的凝血功能指标、滤器凝血指标和使用时间。结果二组PT、APTT差异无统计学意义。干预组跨膜压、滤器压力和使用时间均高于对照组,差异有统计学意义(P<0.05)。结论在必要性中断CRRT治疗时,以模拟治疗方式使血滤机与常规的暂停模式比较能延长滤器使用时间,降低凝血风险和治疗费用,并且对患者凝血功能无影响。

Objective To compare the service time of hemofiltration system under two different standby modes when the renal replacement therapy（CRRT）was suspended during hemoperfusion （HP）.Methods Totally 50 patients with acute pancreatitis in pregnancy caused by hyperlipidemia were randomly divided into improvement group and control groups.Both CRRT and HP were needed in these patients.HP was carried out after 6h CRRT and then CRRT was carried on using the original hemofiltration system.In the improvement group,hemofiltration system was running slowly in the simulated treatment mode by infusing heparin priming fluid through the arterial access and collecting it in a sterile drainage bag on the venous ac-cess.While in the control group,hemofiltration system was in the pause mode.The coagulation index of patients and filters,and the service time of hemofiltration system were compared between the two groups. Results There was no significant difference in prothrombin time （PT）,activated partial thromboplastin time （APTT）between the two groups.In the improvement group,the transmembrane pressure,pressure in the filter were higher,and the service time was longer than the control group （P 〈0.05）.Conclusions Compared with general pause mode,the simulated treatment mode can improve the service time of hemofil-tration system,decrease the coagulated risks of filters and the cost when CRRT has to be suspended,but also has no influence on the coagulation index of patients.