实施简化枸橼酸抗凝后稀释连续性静脉-静脉血液透析滤过治疗时滤后游离钙靶目标校正的研究  

Post-filter ionized calcium target adjusted during simplified regional citrate anticoagulation during postdilution continuous veno-venous hemodiafiltration therapy

作　　者：刘钊 曾一千 袁娇 曾维忠 彭苏娜 Liu Zhao;Zeng Yi-qian;Yuan Jiao;Zeng Wei-zhong;Peng Su-na(Department of Critical Care Medicine,Zhuzhou Central Hospital,Zhuzhou 412007,China)

机构地区：[1]株洲市中心医院重症医学科,株洲412007

出　　处：《临床肾脏病杂志》2022年第3期209-213,共5页Journal Of Clinical Nephrology

摘　　要：目的在实施简化枸橼酸抗凝、采用连续性静脉-静脉血液透析滤过(continuous venovenous hemodiafiltration,CVVHDF)模式后稀释的治疗情况下,在当前公认的滤后游离钙目标控制范围内,探究静脉壶及之后体外管路中血游离钙水平是否达标。如未达标,则进一步探讨新的滤后游离钙控制目标设定。方法纳入重症医学科使用Aquarius机器治疗的62例成人患者,并按随机数字表法分为对照组、试验组。对照组32例患者,其中男16例,女16例;试验组30例患者,包括男16例,女14例。两组患者均为CVVHDF后稀释治疗及简化枸橼酸抗凝,均设立滤后及管路静脉端游离钙监测点,对照组以滤后为离子钙监测点、试验组以静脉端为监测点来监测游离钙水平作为抗凝达标与否指标。收集各时间点外周血、滤后及静脉端游离钙、枸橼酸用量、静脉壶凝血情况、体外循环管路寿命等数据,分析滤后及静脉端游离钙的差异,分析不同游离钙监测点对体外循环管路寿命的影响。结果两组患者静脉端游离钙水平均高于滤后(P<0.01)。试验组静脉壶凝血情况及体外循环寿命均优于对照组(P<0.01)。试验组静脉壶游离钙达标时,滤后游离钙范围在(0.28±0.05)mmol/L,明显低于对照组滤后游离钙水平(P<0.01)。结论在实施简化枸橼酸抗凝后稀释CVVHDF治疗时,静脉端游离钙离子水平高于滤后游离钙离子水平;当后稀释治疗剂量为1 L/h,建议将滤后游离钙控制在不超过0.28 mmol/L,以更好地保护静脉壶,延长体外管路寿命。Objective To explore whether or not bubble chamber ionized calcium(iCa)attained the range of target concentrations during simplified regional citrate anticoagulation during postdilution continuous veno-venous hemodiafiltration(CVVHDF).If not,further research was performed for seeking novel postfilter ionized calcium goal-setting.Methods A total of 62 patients with simplified regional citrate anticoagulation in postdilution CVVHDF therapies in intensive care unit(ICU)were recruited and randomized into two groups of treatment(n=30,16 males and 14 females)and control(n=32,16 males and 16 females).Postfilter iCa was employed a parameter for monitoring the target of control group while return line iCa for monitoring the target of treatment group.The samples were collected for circuit postfilter and venous iCa as well as peripheral blood iCa.Meanwhile,other related data such as bubble chamber clotting and circuit lifespan were recorded.Results Postfilter ionized calcium levels in both groups were significantly higher than return line.Circuit lifespan increased in treatment group as compared with control group.Postfilter ionized calcium level[(0.28±0.05)mmol/L]was significantly lower in treatment group than control group when bubble chamber ionized calcium attained the range of target concentrations.Conclusion It may provide a longer circuit lifespan and reduce chamber clotting during simplified regional citrate anticoagulation in postdilution CVVHDF therapies when postfilter ionized calcium level is not higher than 0.28 mmol/L.

关 键 词：简化枸橼酸抗凝 连续性静脉-静脉血液透析滤过 后稀释 滤后游离钙 

分 类 号：R692.5[医药卫生—泌尿科学]