3种稀释方式在连续静脉-静脉血液滤过治疗中的应用比较

Comparison of the three different dilution methods used in continuous veno-venous hemofiltration

目的比较3种稀释方式在连续性静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH)模式下的应用疗效。方法采用回顾性分析,将2018年1月~2020年8月在安徽医科大学第一附属医院急诊重症监护室(emergency intensive care unit,EICU)住院的90例行连续性静脉-静脉血液滤过治疗患者作为研究对象,根据稀释方式不同分成后稀释组、前后稀释组及前稀释组。比较3组之间滤器使用时长、小分子清除效果、ICU停留时间及28天死亡率。结果3组在性别(χ^(2)=0.287,P=0.866)、年龄(F=0.555,P=0.576)、急性生理学和慢性健康状况评价(acute physiology and chronic health evaluation,APACHE)II评分(F=0.800,P=0.453)、抗凝方式(F=0.480,P=0.787)、诊断(χ^(2)=2.702,P=0.997)等一般资料方面差异无统计学意义;后稀释组、前后稀释组及前稀释组的平均滤器使用时间分别为(18.70±9.64)h、(20.81±9.78)h及(25.83±12.45)h,3组比较差异有统计学意义(F=3.515,P=0.034),且前稀释组平均滤器使用时间长于后稀释组,2组比较具有统计学差异(t=7.130,P=0.012);在小分子清除效果方面,治疗前3组患者的尿素(F=0.065,P=0.937)、肌酐(F=0.347,P=0.708)、乳酸(F=0.112,P=0.894)、血红蛋白(F=0.187,P=0.830)及血小板水平(F=1.826,P=0.167)比较均无统计学意义;治疗8h后3组患者尿素水平比较,差异有统计学意义(F=4.831,P=0.010),且后稀释组低于前稀释组(t=5.512,P=0.003);治疗8h后3组患者肌酐水平比较,差异有统计学意义(F=3.666,P=0.030),且后稀释组与前后稀释组均低于前稀释组(t=59.960,P=0.012;t=46.590,P=0.048);3组患者治疗后乳酸水平相当(F=0.535,P=0.587)。在ICU停留时间方面比较,后稀释组最长,3组之间比较,差异具有统计学意义(F=3.625,P=0.031);后稀释组及前后稀释组死亡率为10%(3例),前稀释组死亡率为13.3%(4例),3组死亡率无统计学意义(χ^(2)=0.225,P=0.894)。结论CVVH治疗中,前稀释方式可以延长滤器使用时间及缩短患者ICU停留时间;后稀释及前后稀释方式在尿素、肌酐等小分子清除效果方面效果更佳,优于前稀释方式。

Objective To compare the efficacy of the three different dilution methods in continuous veno-venous hemofiltration(CVVH)mode.Methods A total of 90 patients treated with CVVH and hospitalized in the Emergency Intensive Care Unit of our hospital between January 2018 and August 2020 were retrospectively studied.According to the dilution method,they were equally divided into post-dilution group,preand post-dilution group,and pre-dilution group.The filter usage period,small molecule removal effect,ICU residence time and mortality were compared between the 3 groups.Results There were no statistical differences in gender(χ^(2)=0.287,P=0.866),age(F=0.555,P=0.576),APACHE(acute physiology and chronic health evaluation)II score(F=0.800,P=0.453),anticoagulation method(F=0.480,P=0.787)and diagnosis(χ^(2)=2.702,P=0.997)among the 3 groups.The average filter usage periods were 18.70±9.64 hours,20.81±9.78 hours and 25.83±12.45 hours in post-dilution group,pre-and post-dilution group and pre-dilution group respectively(F=3.515,P=0.034),and the average filter usage period was longer in pre-dilution group than in post-dilution group(t=7.130,P=0.012).In terms of small molecule removal effect,there were no statistical differences in serum urea(F=0.065,P=0.937),creatinine(F=0.347,P=0.708),lactic acid(F=0.112,P=0.894),hemoglobin(F=0.187,P=0.830)and platelet(F=1.826,P=0.167)before the treatment among the 3 groups.After the treatment for 8 hours,serum urea was different among the 3 groups(F=4.831,P=0.010),and was low-er in post-dilution group than in pre-dilution group(t=5.512,P=0.003).Serum creatinine level was different among the 3 groups(F=3.666,P=0.030),and was lower in post-dilution group and pre-and post-dilution group than in pre-dilution group(t=59.960 and 46.590,P=0.012 and 0.048).There were no significant differences in serum lactic acid among the 3 groups(F=0.535,P=0.587).The ICU residence time was different among the 3 groups(F=3.625,P=0.031),with the longest in post-dilution group.The 28-day mortality rates were 10%(3 cases),10%(3 cases),and 13.3%(4 cases)in post-dilution group,pre-and post-dilution group and pre-dilution group respectively,without statistical significances among the 3 groups(χ^(2)=0.225,P=0.894).Conclusions In CVVH,the pre-dilution method had the advantages of longer filter usage period and shorter ICU residence time of the patients,while the post-dilution and pre-and post-dilution methods had better effects on removal of small molecules such as urea and creatinine than pre-dilution method.