不同剂量CRRT对危重患者血乳酸清除的影响

Effect of different doses of continuous renal replacement therapy(CRRT) on blood lactate clearance in critical patients

目的观察不同剂量持续性肾脏替代治疗(CRRT)对危重患者血乳酸(BLa)清除程度的影响。方法 24例危重患者根据BLa水平归入4组(A组:BLa<2 mmol/L;B组:2 mmol/L≤BLa<4 mmol/L;C组:4 mmol/L≤BLa<8 mmol/L;D组:BLa≥8 mmol/L),每组依次接受25、35、45 m L/(kg·h)剂量的CRRT,每次1 h。根据CRRT前后BLa浓度计算BLa清除率及清除量。结果同组中CRRT剂量越大,BLa清除率越大(P<0.05或0.01),但BLa清除量差异无统计学意义(P>0.05)。相同CRRT剂量时,各组BLa清除率差异无统计学意义(P>0.05),但C、D组BLa清除量明显大于A、B组(P<0.05或0.01)。结论 CRRT剂量影响危重患者BLa清除率,而初始BLa水平影响乳酸清除量。

Objective To observe the impact of different doses of continuous renal replacement therapy（CRRT） on blood lactate（BLa） clearance in critical patients. Methods Twenty-four critical patients were categorized into 4 groups based on their BLa levels（Group A： BLa〈2 mmol/L; Group B：2 mmol/L≤BLa〈4 mmol/L; Group C：4 mmol/L≤BLa〈8 mmol/L; Group D： BLa≥8 mmol/L）. Each group received in turn 25,35,and 45 m L/（kg·h） of CRRT for 1 hour. The clearance rate and volume of BLa were calculated using BLa levels of pre- and post-CRRT. Results In the same group,BLa clearance rates were increased with CRRT doses（P〈0.01 or 0.05）,but BLa clearance volumes were not（P〈0.05）. In the same CRRT dose,BLa clearance rates were similar among all groups（P〈0.05）,whereas BLa clearance volumes were higher in Groups C and D than in Groups A and B（P〈0.01 or 0.05）. Conclusion The BLa clearance rates and volumes can be dependent on the CRRT doses and initial BLa contents,respectively.