连续性肾脏替代治疗行枸橼酸体外抗凝补碱策略对比研究

Two different alkali supplement strategies in continuous renal replacement therapy （CRRT） with citrateanticoagulation

目的比较两种不同补碱策略在连续性肾脏替代治疗（CRRT）行枸橼酸抗凝中的效果。方法选取2013年5月至2015年4月于本院接受CRRT的患者63例，采用连续静脉一静脉血液滤过（CVVH）模式进行CRRT，采用枸橼酸抗凝行CRRT，随机分为两组，均行后稀释法，对照组根据置换液量计算补碱量；治疗组根据每小时枸橼酸进入人体量，推算生成碳酸氢根量，校正补碱量。比较两种补碱策略的人体酸碱平衡、CRRT的滤器寿命、钙值、跨膜压（TMP）、病死率。结果两组滤器寿命、滤器后离子钙值、TMP及病死率无明显差异（P〉0．05）；但在CVVH4h后，对照组体内HCO，一均较治疗组升高，12h后对照组pH升高明显，差异均有统计学意义（P〈0．05），对照组在CVVH4～6h后均需调整补碱速度，直至体内酸碱平衡相对稳定。结论患者行CRRT枸橼酸抗凝时，根据枸橼酸入量校正补碱量，简单、安全、有效，可减少酸碱失衡的发生，进而减少监测血气分析频率。

Objective To compare two different alkali supplement strategies in contilmous renal replacement therapy （CRRT） with citrate anticoagulation. Methods 63 patients undertaking CRRT at our hospital from May, 2013 to April 2015 were selected. CRRT was carried out using continuous veno-venous hemofiltration （CVVH） mode and citrate anticoagulation. The patients were randomly divided into a control group and a treatment group. Post dilution method was used in both groups. The amount of alkali supplement was calculated in term of the volume of replacement fluid in the control group; the alk. i amount was corrected according the amount of HCO3 generated by the citrate dripped into the patientsodies one hour in the treatment group. The acid-base balance, CRRT filter＇s life time, calcium value, transmembrane pressure （TMP and mortality were compared between these two groups. Results There wer no statistical differences in life time, calcium value, TMP, and mortaqty bween these two groups （P〉 0.05）. 4 hours after CVVH, the ,evel of HCO3 was higher in the control grou than in the treatment group; 12 hours after CVVH, pH was higher in the cool group than in the treatment grog; with statistical differences （P〈0.05）. 4-6 hours after CVVH, the speed of al di supplement had to be adjusted oatil the acid-base balance was relatively stable. Conclusions When patients ＇e undertaking CRRT under citrate ..nticoagulation, alkali amount should be adjust according to citrate amount. 1 ＇s simple, safe, and effective and can reduce the occurrence of acid-base imbalance and the frequency of monitor ng blood gas analysis.