滤器冲洗对无抗凝剂CRRT净化效果的影响

The effects of filter washing on blood purification in CRRT with non-anticoagulant

目的:探讨在无抗凝剂连续肾脏替代治疗(CRRT)患者中,间断生理盐水冲洗滤器不同冲洗频率和冲洗量对血液净化效果的影响。方法:便利选取某市三级甲等医院2013年10月至2015年8月住院并行无抗凝剂CRRT的患者240例,按冲洗间隔时间和冲洗量顺次组合为12组,再按患者入院时间依次分配入各组。12组分别为:A组每30 min用100 ml生理盐水冲洗滤器,B组每60 min用100 ml生理盐水冲洗滤器,C组每90 min用100 ml生理盐水冲洗滤器,D组每120 min用100 ml生理盐水冲洗滤器,E组每30 min用150 ml生理盐水冲洗滤器,F组每60 min用150 ml生理盐水冲洗滤器,G组每90 min用150 ml生理盐水冲洗滤器,H组每120 min用150 ml生理盐水冲洗滤器,I组每30 min用200 ml生理盐水冲洗滤器,J组每60 min用200 ml生理盐水冲洗滤器,K组每90 min用200 ml生理盐水冲洗滤器,L组每120 min用200 ml生理盐水冲洗滤器。收集并观察各组血肌酐、尿素氮指标的变化情况。结果:本研究中的不同冲洗频率对血肌酐(P=0.000)和尿素氮(P=0.000)的清除效果有影响,冲洗频率增大,血肌酐和尿素氮下降程度减小。不同冲洗量对血肌酐(P=0.038)和尿素氮(P=0.017)的清除效果有影响,冲洗量增大,血肌酐和尿素氮下降程度减小。结论:无抗凝剂CRRT中的增大生理盐水冲洗滤器的频率与量均降低对血肌酐和尿素氮的清除。

Objective： To explore the effects of different washing frequencies and volumes on blood purification outcome in patients treated with non-anticoagulant continuous renal replacement therapy（ CRRT） using intermittent physiological saline washing filter. Methods： 240 patients who had been hospitalized in grade three- level A hospitals of XX city during October,2013 to August,2015 and treated with non- anticoagulant CRRT were selected. There were 12 groups after combining different washing intervals and different washing volumes in different sequences. The patients were assigned to each group in the order of admission. The 12 groups included：100 ml every 30 minutes in Group A,100 ml every 60 minutes in Group B,100 ml every 90 minutes in Group C,100 ml every 120 minutes in Group D,150 ml every 30 minutes in Group E,150 ml every 60 minutes in Group F,150 ml every 90 minutes in Group G,150 ml every 120 minutes in Group H,200 ml every 30 minutes in Group I,200 ml every 60 minutes in Group J,200 ml every 90 minutes in Group K,200 ml every 120 minutes in Group L.Data on the changes of serum creatinine（ CRE） and blood urea nitrogen（ BUN） were collected and observed.Results： In this study,taking different washing frequencies had an effect on the clearance of CRE（ P = 0. 000）and BUN（ P = 0. 000）. Decrease of CRE and BUN got less as washing frequency increased. Taking different washing volume also had an effect on the clearance of CRE（ P = 0. 038） and BUN（ P = 0. 017）. Decrease of CRE and BUN got less as washing volume increased. Conclusion： Increasing the frequency or volume of physiological saline washing filter decreases the clearance of CRE and BUN in non-anticoagulant CRRT.