BACKGROUND:The study aims to investigate an optimal indicator for changing the filter during the continuous renal replacement therapy(CRRT)in intensive care unit(ICU)patients with acute kidney injury(AKI).METHODS:Pati...BACKGROUND:The study aims to investigate an optimal indicator for changing the filter during the continuous renal replacement therapy(CRRT)in intensive care unit(ICU)patients with acute kidney injury(AKI).METHODS:Patients with AKI requiring CRRT in an ICU were randomly divided into two groups for crossover trial,i.e.,groups A and B.Patients in the group A were firstly treated with continuous veno-venous hemofiltration(CVVH),followed by continuous veno-venous hemodiafiltration(CVVHDF).Patients in the group B were firstly treated with CVVHDF followed by CVVH.Delivered doses of solutes with different molecular weights at the indicated time points between groups were compared.A correlation analysis between the delivered dose and pre-filter pressure(P_(PRE))and transmembrane pressure(P_(TM))was performed.Receiver operating characteristic(ROC)curves were constructed to evaluate the accuracy of P_(TM) as an indicator for filter replacement.RESULTS:A total of 50 cases were analyzed,27 in the group A and 23 in the group B.Delivered doses of different molecular-weight solutes significantly decreased before changing the filter in both modalities,compared with those at the initiation of treatment(all P<0.05).In the late stage of CRRT,the possible rebound of serum medium-molecular-weight solute concentration was observed.P_(TM) was negatively correlated with the delivered dose of medium-molecular-weight solute in both modalities.The threshold for predicting the rebound of serum concentration of medium-molecularweight solute by P_(TM) was 146.5 mm Hg(1 mm Hg=0.133 k Pa).CONCLUSIONS:The filter can be used as long as possible within the manufacturer’s safe use time limits to remove small-molecular-weight solutes.P_(TM) of 146.5 mm Hg may be an optimal indicator for changing the filter in CRRT therapies to remove medium-molecular-weight solutes.展开更多
目的探讨心源性卒中患者使用丁苯酞对华法林抗凝作用的影响。方法前瞻性连续纳入成都医学院第一附属医院神经内科2019年6月—2021年12月期间收治的心源性卒中患者,患者入组后随机分为试验组(华法林+丁苯酞)和对照组(华法林)。监测两组...目的探讨心源性卒中患者使用丁苯酞对华法林抗凝作用的影响。方法前瞻性连续纳入成都医学院第一附属医院神经内科2019年6月—2021年12月期间收治的心源性卒中患者,患者入组后随机分为试验组(华法林+丁苯酞)和对照组(华法林)。监测两组患者的国际标准化比值(international standardized ratio,INR)变化情况并收集两组患者的临床资料,比较分析两组患者的INR达标时间、2周内达标率和90 d mRS评分的差异。结果本研究共纳入101例心源性卒中患者,试验组51例,对照组50例。两组基线数据(年龄、性别、用药前INR、收缩压和舒张压)差异无统计学意义,入院时试验组的NIHSS评分[10(3.0~15.0)分vs.0(0~6.5)分,P<0.001],溶栓率(27.5%vs.8.0%,P=0.011)与取栓率(25.5%vs.2.0%,P=0.001)均高于对照组。试验组INR 2周内达标率与对照组相比差异无统计学意义(43.1%vs.44.0%,P=0.930)。试验组达标时间较对照组明显缩短[(6.50±2.41)d vs.(9.64±4.40)d,P=0.015]。试验组90 d mRS评分与对照组相比,差异无统计学意义[3(0.5~4.0)分vs.2(0~3.0)分,P=0.175]。结论丁苯酞联合华法林治疗心源性卒中可能缩短华法林的达标时间,需进一步的研究来验证,但对于INR的达标率和90 d mRS评分无影响。展开更多
基金supported by Kunshan Science and Technology Special Fund(Social Development Category,KS18040)。
文摘BACKGROUND:The study aims to investigate an optimal indicator for changing the filter during the continuous renal replacement therapy(CRRT)in intensive care unit(ICU)patients with acute kidney injury(AKI).METHODS:Patients with AKI requiring CRRT in an ICU were randomly divided into two groups for crossover trial,i.e.,groups A and B.Patients in the group A were firstly treated with continuous veno-venous hemofiltration(CVVH),followed by continuous veno-venous hemodiafiltration(CVVHDF).Patients in the group B were firstly treated with CVVHDF followed by CVVH.Delivered doses of solutes with different molecular weights at the indicated time points between groups were compared.A correlation analysis between the delivered dose and pre-filter pressure(P_(PRE))and transmembrane pressure(P_(TM))was performed.Receiver operating characteristic(ROC)curves were constructed to evaluate the accuracy of P_(TM) as an indicator for filter replacement.RESULTS:A total of 50 cases were analyzed,27 in the group A and 23 in the group B.Delivered doses of different molecular-weight solutes significantly decreased before changing the filter in both modalities,compared with those at the initiation of treatment(all P<0.05).In the late stage of CRRT,the possible rebound of serum medium-molecular-weight solute concentration was observed.P_(TM) was negatively correlated with the delivered dose of medium-molecular-weight solute in both modalities.The threshold for predicting the rebound of serum concentration of medium-molecularweight solute by P_(TM) was 146.5 mm Hg(1 mm Hg=0.133 k Pa).CONCLUSIONS:The filter can be used as long as possible within the manufacturer’s safe use time limits to remove small-molecular-weight solutes.P_(TM) of 146.5 mm Hg may be an optimal indicator for changing the filter in CRRT therapies to remove medium-molecular-weight solutes.
文摘目的探讨心源性卒中患者使用丁苯酞对华法林抗凝作用的影响。方法前瞻性连续纳入成都医学院第一附属医院神经内科2019年6月—2021年12月期间收治的心源性卒中患者,患者入组后随机分为试验组(华法林+丁苯酞)和对照组(华法林)。监测两组患者的国际标准化比值(international standardized ratio,INR)变化情况并收集两组患者的临床资料,比较分析两组患者的INR达标时间、2周内达标率和90 d mRS评分的差异。结果本研究共纳入101例心源性卒中患者,试验组51例,对照组50例。两组基线数据(年龄、性别、用药前INR、收缩压和舒张压)差异无统计学意义,入院时试验组的NIHSS评分[10(3.0~15.0)分vs.0(0~6.5)分,P<0.001],溶栓率(27.5%vs.8.0%,P=0.011)与取栓率(25.5%vs.2.0%,P=0.001)均高于对照组。试验组INR 2周内达标率与对照组相比差异无统计学意义(43.1%vs.44.0%,P=0.930)。试验组达标时间较对照组明显缩短[(6.50±2.41)d vs.(9.64±4.40)d,P=0.015]。试验组90 d mRS评分与对照组相比,差异无统计学意义[3(0.5~4.0)分vs.2(0~3.0)分,P=0.175]。结论丁苯酞联合华法林治疗心源性卒中可能缩短华法林的达标时间,需进一步的研究来验证,但对于INR的达标率和90 d mRS评分无影响。
