连续肾脏替代疗法中容量管理与中心静脉压和血容量的关系

The relationship between capacity management and central venous pressure and blood volume in continuous renal replacement therapy

目的探讨行连续肾脏替代疗法（CRRT）患者的红细胞参数与连续中心静脉压、血容量的关系，以指导患者的液体管理。方法该研究有2个实验阶段，第一实验阶段：护士观察行连续。肾脏替代疗法患者的红细胞参数和连续中心静脉压（CVP）之间的关系，以此探寻患者的最佳CVP和相应的最佳红细胞参数平均值；第二实验阶段：护士利用最佳红细胞参数平均值指导液体管理。分别比较第二阶段患者扩容或利尿前后的CVP变化。结果①第一阶段，CVP〉10等级的RBC、Hb、HCT均显著低于CVP〈8、CVP8～10等级，CVP8～10等级的Hb显著低于CVP〈8，差异均有统计学意义（均P〈0．05）。CVP与SBP、MAP、HR、RBC、Hb、HCT呈显著负相关，RBC与Hb、HCT呈显著正相关，Hb与HCT呈显著的正相关。患者CVP的最佳值为8～10cmH2O时生命体征较稳定，相应的红细胞参数最佳值为RBC3．44×10 9／L，Hb96．8g／L，HCT0．310。②第二阶段，该组患者的CVP最佳值定为8～10cmH2O，相应的最佳Hb值为102g／L。Hb水平〈102g／L时，与治疗前比较，经利尿治疗后CVP明显下降，差异有统计学意义（P〈0．01）；Hb水平〉102g／L时，与治疗前比较，经补充液体后CVP明显升高，差异有统计学意义（P〈0．01）。结论CVP与红细胞各参数呈显著负相关，CVP最佳值对应的红细胞参数最佳值对行连续肾脏替代疗法患者的液体管理可能有一定的指导意义。

Objective To investigate the correlate of erythrocyte parameters, central venous pressure and blood volume in ICU patients with continuous renal replacement therapy （CRRT） , in order to guide the fluid management. Methods The study included two stages. The first stage observed the relation between erythrocyte parameters and central venous pressure （CVP） in ICU patients with CRRT, so that explored the optimum CVP and the optimum erythrocyte parameters. The second stage was to guide the fluid management using the optimum erythrocyte parameters, and analyzed the change of CVP before and after the treatment of fluid expansion or diuresis. Results （1）In the first stage,when the class of CVP was 〉10, RBC, Hb and HCT were significantly lower than it of the classes of CVP〈8 and CVP 8 - 10. For the Hb in the class range of CVP 8 - 10, it was significantly lower than CVP〈8, and the difference had statistical significance （P〈0. 05 ）. CVP had significant negative correlations with SBP, MAP, HR, RBC, Hb and HCT. RBC had significant positive correlations with Hb and HCT. Hb had significant positive correlations with HCT. When the optimum value of CVP of patients was at 8 - 10 cmH20, the vital sign was stable. The optimum values of the corresponding red blood cell parameters were RBC 3.44×10 9/L, Hb 96.8 g/L, HCT 0. 310. （2） In the second stage, the optimum value of CVP of patients in this group was set as 8 - 10 cm H20. The corresponding optimum Hb 102 g/L. When Hb level was 〈102g/L, compared with it before treatment, CVP level had dramatic decline resis treatment, and the difference had statistical significance （P〈0. 01 ）. When Hb level was 〉 102 g/L, value was after diucompared with it before treatment, CVP level increased significantly after adding fluid, and the difference had statistical significance （P〈0. 01 ）. Conclusions CVP has significant negative correlations with the parameters of red blood cells. The corresponding optimum value of red blood cells to the optimum value of CVP had some guiding significance on the fluid management to the patients of continuous kidney substitution therapy.