正-反向连接血液透析导管对首次连续性肾脏替代治疗急性肾损伤患者影响的初步探讨

Preliminary study on the effect of positive-negative blood dialysis catheter on the first continuous renal replacement therapy in patients with acute kidney injury

目的 探讨正-反向连接血液透析导管对连续性肾脏替代治疗（CRRT）治疗急性肾损伤（AKI）患者的影响.方法 选择需要行CRRT的AKI Ⅲ期患者90例,根据有无反向连接血液透析导管,将其分为正向连接组（45例）和正-反向连接组（45例）,比较两组患者在首次行CRRT过程中的滤器寿命、液体平衡量和清除溶质效率,以及镇静剂与抗凝剂的使用剂量,并比较两组患者导管相关性感染和预后指标.结果 两组患者额外液体入量、液体负平衡以及CRRT运行中断时间、入住ICU时间和花费方面比较差异均有统计学意义（P〈0.05）;而滤器寿命、CRRT有效滤过时间和肌酐、胱抑素C及尿素氮清除效率、镇静剂（咪哒唑仑和丙泊酚）用量、抗凝剂枸橼酸用量、导管相关性感染、28d与60d肾功能恢复正常的病例数比较差异均无统计学意义（P〉0.05）.结论 CRRT过程中使用正-反向连接血液透析导管能明显增加液体输入量,不利于AKI的短期恢复,但对CRRT的清除效率和AKI远期的影响较小.

Objective To investigate the effect of positive-negative blood dialysis catheter on continuous renal replacement therapy（CRRT） in patients with acute renal injury（AKI）.Methods Ninety AKI Ⅲ patients with CRRT were selected and divided into the positive connection group（45 patients） and the positive-negative connection group（45 patients） according to whether there was reverse connection of hemodialysis catheter.The life of the filter,the equilibrium amount of liquid and the efficiency of the removal of the solute were compared between the two groups during the first CRRT,then the use dosage of sedative and anticoagulants were compared,finally the indicators of infection and prognosis of the two groups were compared.Results Extra fluid intake,negative balance of fluid and interruption time on CRRT,ICU time and cost in two groups were significantly different（P〈0.05）.And the filter life,effective filtration time,the scavenging effect of creatinine,Cystatin C and urea,sedatives（midazolam and propofol） dosage,anticoagulant citrate dosage,catheter-related infection,the recovery normal cases of 28 days and 60 days of renal function were unsignificantly different（P〉0.05）.Conclusion The use of positive-negative connecting blood dialysis catheter can significantly increase the amount of liquid input,which is not benefit to short-term recovery of AKI,but has less effect on CRRT removal efficiency and AKI long-term impact.