重型颅脑损伤并急性肾功能衰竭患者在不同CVVH方式下滤器寿命比较研究

A Comparative Study of filter life in different CVVH way for the severe brain injury patients with acute renal failure

目的重型颅脑损伤患者进行连续静脉静脉血液滤过（Continuous veno—venons hemofiltration，CVVH）时使用局部枸橼酸抗凝和全身普通肝素抗凝有效性和安全性比较。方法回顾性分析2008年12月一2014年12月我院重症医学科因急性肾功能衰竭接受CVVH治疗的64例重型颅脑损伤患者共行128次CVVH，按抗凝方式分为局部枸橼酸抗凝组（A组，70次）和全身肝素抗凝组（B组，58次），比较两组滤器寿命、血滤停止的原因。结果A组滤器寿命明显长于B组[58．2h（35．6～72．4h）h对19．4h（8．3～37．1h），P〈0．01]，Kaplan—Meier生存分析法显示两组滤器寿命差异有统计学意义（P〈0．01）；因凝血导致血滤终止的比例B组为87．9％（51／58），显著高于A组44．3％（31／70）（P=0．001）。结论与全身普通肝素抗凝相比，重型颅脑损伤患者进行CVVH时采用局部枸橼酸抗凝，滤器寿命明显延长。

Objective To compare efficacy and safety of regional citrate anticoagulation with systemic hcparin in continuous veno-venous hemofiltration （CVVH） for patients with severe brain disease. Methods A retrospective analysis was performed on 64 severe brain disease patients who were given a total of 128 CVVH treatments due to acute renal failure in between December 2008 and December 2014 in department of critical care medicine in our hospital. According to regional citrate anticoagulation, they were divided into citrate group （group A, N=70） and systemic heparin group （group B, N=58）, and the filter life of two groups were compared, as well as the reasons for hemofihration termination. Results There was a significantly longer in filer life of group A than group B, 58.2 hours （35.6-72.4 h） vs. 19.4 hours （ 8.3-37.1 h）, P 〈0.01. Kaplan-Meier survival analysis revealed that difference between the two groups was statistically significant （P 〈0.01）; due to proportion of blood clotting, the rate of group B＇ s filter termination was 87.9% （51/58）, significantly higher than group A＇s 44.3% （31/70）, （P = 0.001）. Conclusion Comparing with systemic heparin anticoagulation in patients with severe traumatic brain injury, using CVVH with regional citrate anticoagulation carries out a significantly longer filter life.