基于改良Aquarius CRRT实现血浆胆红素吸附联合CVVH的疗效分析

An analysis on therapeutic effect of basically using modified Aquarius continuous renal replacement therapy to

目的：观察改良日机装Aquarius连续性肾脏替代治疗（CRRT）实现血浆胆红素吸附（BA）联合连续性静脉-静脉血液滤过（CVVH）的疗效。方法收集2014年2月至2016年7月在中南大学湘雅医院重症医学科住院的高胆红素血症患者8例，所有患者均给予基本内科综合治疗，同时在此基础上实施BA联合CVVH治疗共25例次。观察患者治疗前后白蛋白（ALB）、总胆红素（TBil）、直接胆红素（DBil）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）等肝功能指标及凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶原活动度（PTA）、国际标准比值（INR）等凝血指标和血常规〔白细胞计数（WBC）、血小板计数（PLT）〕的变化，以及电解质和不良反应发生情况。结果治疗后1 h ALB（g/L：26.84±4.07比29.46±3.78）和治疗后1 h、24 h TBil、DBil均较治疗前明显降低〔TBil（μmol/L）：262.81±88.85、297.26±96.64比357.57±121.86，DBil （μmol/L）：129.84±42.24、141.60±49.60比173.76±56.22〕，治疗后1 h PT较治疗前明显延长（s：20.97±8.66比16.59±2.70），差异均有统计学意义（均P＜0.05）；而治疗前后ALT、AST、APTT、PTA、INR、WBC、PLT和电解质水平（K＋、Na＋）比较差异均无统计学意义（均P＞0.05）。结论在不改变现有设备硬件的情况下，对日机装Aquarius CRRT血液净化装置进行改良实现BA后再序贯进行CVVH治疗，充分发挥了两种模式的治疗作用，可以达到清除胆红素及水溶性毒素的目的。

ObjectiveTo observe the therapeutic efficacy of basically using modified Aquarius continuous renal replacement therapy （CRRT） to realize bilirubin adsorption （BA） combined with sequential continuous vein to vein hemofiltration （CVVH）.Methods Eight patients with hyper-bilirubinemia admitted to Department of Critical Care Medicine in Xiangya Hospital of Central South University during February 2014 and July 2016 were enrolled, they were given basic comprehensive medical treatments, and in the mean time, BA combined with CVVH were carried out, totally 25 case times. The levels of albumin （ALB）, total bilirubin （TBiL）, direct bilirubin （DBil）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST） etc. liver function indexes, blood coagulation indexes such as prothrombin time （PT）, activated partial thromboplastin time （APTT）, prothrombin activity （PTA）, international standard ratio （INR）, routine blood indicators white blood cell count （WBC）, platelet count （PLT）, electrolytes were observed before and after treatment, and adverse reactions were recorded.Results After treatment for 1 hour, ALB （g/L：26.84±4.07 vs. 29.46±3.78） and TBil, DBil after treatment for 1 hour, 24 hours were lower than those before treatment [TBil （μmol/L）： 262.81±88.85, 297.26±96.64 vs. 357.57±121.86, DBil （μmol/L）： 129.84±42.24, 141.60±49.60 vs. 173.76±56.22]; after treatment for 1 hour, PT was significantly longer compared with that before treatment （s： 20.97±8.66 vs. 16.59±2.70）, the difference being statistically significant （allP 0.05） in ALT, AST, APTT, PTA, INR, WBC, PLT and electrolyses （K＋, Na＋）.Conclusions Using the Japanese modified Aquarius CRRT blood purification device without changing its hard-ware to realize plasma BA and then combined with sequential CVVH therapy can fully play their roles in eliminating bilirubin and water-soluble toxins for treatment of patients with hyper-bilirubinemia.