重症患者局部枸橼酸抗凝行连续性静脉-静脉血液滤过离子钙浓度的探讨  

Post-filter ionic calcium concentration during continuous venous-venous hemofiltration under regional citrate anti-coagulation in critical patients

作　　者：王妍[1] 张北源[1] 郭晓芳[1] 曹科[1] 陈显成[1] 冯芜若 尤勇[1] 陈鸣[1] 虞文魁 朱章华[1] WANG Yan;ZHANG Beiyuan;GUO Xiaofang;CAO Ke;CHEN Xiancheng;FENG Wuruo;YOU Yong;CHEN Ming;YU Wenkui;ZHU Zhanghua(Department of Critical Care Medicine,Nanging Drum Tower Hospital Affiliated to Nanjing University Medical School,Nangjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院重症医学科,南京210008

出　　处：《肾脏病与透析肾移植杂志》2021年第2期119-123,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金委员会资助项目(81701953)。

摘　　要：目的:观察连续性静脉-静脉血液滤过(CVVH)局部枸橼酸抗凝(RCA)参数设置及滤器后钙离子([iCa^(2+)]_(post-filter))水平与滤器寿命的关系.方法:回顾2016年6月1日至2017年7月31日期间鼓楼医院重症医学科RCA的CVVH患者.设定血流速度和枸橼酸钠速度不变(血流量180 ml/min,4%枸橼酸钠220 ml/h),观察血滤期间内环境情况、滤器寿命.按[iCa^(2+)]_(post-filter)分为C1组(≤0.45 mmol/L)、C2组(0.45 mmol/L<[Ca^(2+)]_(post-filter)≤0.55 mmol/L)、C3组([iCa^(2+)]_(post-filter)>0.55 mmol/L),观察各组滤器寿命(h)和滤器48h存活率.按滤器寿命分为T1组(t≤24h)、T2组(24h<t≤48h)、T3组(t>48h),比较各组[iCa^(2+)]post-filter水平.分析[iCa^(2+)]_(post-filter)与滤器寿命是否存在相关性.结果:共纳入56例患者114例次CVVH.(1)滤器平均寿命46.27±18.82h,平均[iCa^(2+)]po-filter0.52±0.08 mmol/L,体内钙离子1.01±0.19 mmol/L;(2)所有患者CVVH期间未出现明显出血、代谢紊乱等并发症;(3)不同[iCa^(2+)]_(post-filter)组滤器寿命分别是C1组:41.93±17.26h,C2组:47.75±19.91h,C3组:46.45±17.99h,三者之间无统计学意义;48h滤器"存活率"分别是33.33%、43.86%、47.22%,三组之间无统计学差异.(4)T1组、T2组、T3组的[iCa^(2+)]_(post-filter)分别是:0.49±0.07 mmol/L、0.51±0.08 mmol/L、0.53±0.07 mmol/L,三组之间无统计学差异.(5)[iCa^(2+)]_(post-filter)与滤器寿命进行相关性分析,发现两者无相关性.结论:枸橼酸与血流速度设定为合适的固定比例时,可适当放宽[iCa^(2+)]post-filter的目标范围,对滤器使用寿命影响较小,且安全性较好.Objective:To study parameters setting and the relationship between post-filter ionized calcium concentrations([iCa^(2+)]_(post-filter))and lifespans of filters during continuous venous-venous hemofiltration under regional citrate anticoagulation(RCA-CVVH).Methodology:Patients treated with RCA-CVVH from June 1st 2016 to July 31st 2017,were enrolled in the study.Blood flow velocity and sodium citrate velocity were set unchanged(blood flow:180ml/min,4%sodium citrate:220 ml/h).The internal environment and lifespans of filters were observed during hemofiltration.According to different values of[iCa^(2+)]_(post-filter),the data was divided into three groups:Group C_(1)[iCa^(2+)]_(post-filter)≤0.45 mmol/L),Group C_(2)(0.45[iCa^(2+)]_(post-filter)≤0.55 mmol/L),Group C_(3)([iCa^(2+)]_(post-filter)>0.55mmol/L).The lifespans of filters and surviving rates in 48th hour were compared.According to different lifespans of filters,the data was divided into three groups:Group T1(t≤24h),Group T2(24h<t≤48h),Group T3(t>48h).[Ca^(2+)]post filter of three groups were compared.The relation of[iCa^(2+)]_(post-filter)and lifespans of filters were analyzed.Results:Totally 56 patients and 114 times of CVVH in the same setting were enrolled.(1)The mean lifespan was 46.27±18.82h,and the mean[iCa^(2+)]_(post-filter)was 0.52±0.08mmol/L,the mean systemic iron calcium was 1.01±0.19mmol/L.(2)There were no bleeding,metabolism disarrangements during RCA-CVVH.(3)The lifespans of Group C1,C2 and C3 were 41.93±17.26h,47.75±19.91h and 46.45±17.99h individually,and there was no statistical difference among the three groups(F=0.73,P>0.05).The 48h“surviving rates“were 33.33%,43.86%,47.22%.Differences were not signifcant(χ2=1.08,P>0.05).(4)[iCa^(2+)]_(post-filter)in group T1,T2 and T2,were 0.49±0.07、0.51±0.08、0.53±0.07mmo/L(F=1.86,P>0.05).There was no statistical difference among the three groups.(5)The r-value for the correlation between[iCa^(2+)]_(post-filter)and lifespans of filters was 0.13(P>0.05).Conclusion:To maintain a fixe

关 键 词：枸橼酸 持续静脉-静脉血液滤过 局部枸橼酸抗凝 

分 类 号：R459.5[医药卫生—治疗学]