基于Diapact连续性肾脏替代治疗装置实现连续性血浆吸附滤过功能的临床安全性研究

A clinical security research on function of continuous plasma filtration adsorption therapy based on Diapact continuous renal replacement therapy device

目的探讨基于Diapact连续性肾脏替代治疗（CRRT）装置实现连续性血浆吸附滤过（CPFA）功能的临床可行性、安全性及连续性的研究。方法收集2010年1月至2013年12月武警后勤学院附属医院呼吸与重症医学科收治的中毒患者行CPFA（A组）及连续性静脉一静脉血液滤过（CVVH，B组）患者的临床资料，每组62例次。对比分析两组患者治疗开始后5、10、20、30min收缩压（SBP）、心率（HR）、中心静脉压（CVP）变化，以及治疗开始后30min和3、6、12h患者的凝血功能，血流速、动脉压、滤前压、静脉压、跨膜压、滤压降幅。结果两组患者治疗开始后各时间点SBP、HR、CVP、凝血功能、血流速、动脉压、跨膜压比较差异均无统计学意义（均P〉0．05）；而A组治疗开始后30min和3、6、12h滤前压、滤压降幅明显高于B组，差异有统计学意义l滤前压（mmHg，1mmHg=0．133kPa）分别为：189．0±6．6比170．0±6．4，189．0±7.3比169．0±7．8，189．0±6．8比171．0±6．4，190．0±6．2比173．0±6．4；滤压降幅（mmHg）分别为：160．0±4．7比138．0±4．6，159．0±4．7比137．0±4．8，166．0±3．8比138．0±4．3，161．0±4.3比139．0±3．8，均P〈0．01]。结论CPFA治疗对患者凝血功能影响不明显，无临床出血并发症，临床使用是安全的。

Objective To study the clinical application and security of continuous plasma filtration adsorption （CPFA） therapy based on Diapact continuous renal replacement therapy （CRRT） device. Methods Sixty-two patients with intoxication having carried out CPFA once for everyone were assigned in A group, while another sixty-two such patients having undertaken continuous veno - venous hemofihration （CVVH） once for everyone were assigned in B group. The above patients＇ clinical data were collected from the departments of respiratory and critical care medicine in Affiliated Hospital of Logistic University of Chinese People＇s Armed Police Forces from January 2010 to December 2013. The changes of systolic blood pressure （SBP）, heart rate （HR） and central venous pressure （CVP） after treatment for 5, 10, 20, 30 minutes, and the patients＇ coagulation function, blood flow speed, arterial pressure, pre-fiher pressure, venous pressure, trans-memhrane pressure, filter pressure drop amplitude after treatment for 30 minutes and 3, 6, 12 hours were analyzed in the two groups and compared between them. Results There were no statistically significant differences in SBP, HR, CVP, coagulation function, blood flow speed, arterial pressure, trans-membrane pressure in the comparisons between the two groups after treatment at various time points （all P 〉 0.05）. However, the pre-fiher pressure and filter pressure drop amplitude in A group were significantly higher than those in B group at the time points after treatment for 30 minutes, 3, 6, 12 hours, the differences being statistically significant [pre-fiher pressure （mmHg, 1 mmHg = 0.133 kPa）： 189.0±6.6 vs. 170.0±6.4, 189.0±7.3 vs. 169.0±7.8, 189.0±6.9 vs. 171.0±6.4, 190.0±6.2 vs. 173.0±6.4; filter pressure drop （mmHg）： 160.0 ± 4.7 vs. 138.0 ± 4.6, 159.0 ± 4.7 vs. 137.0 ± 4.8, 166.0 ± 3.8 vs. 138.0 ± 4.3, 161.0 ± 4.3 vs. 139.0 ± 3.8, all P 〈 0.01]. Conclusions CPFA therapy has no significant influence on patients＇ blood coagulation, and no hemorrhagic complication clinically, thus its clinical application is safe.