CRRT与ECMO不同连接方案对CRRT动脉端和静脉端压力的影响——一项体外和体内研究  

Effect of different connection schemes of continuous renal replacement therapy and extracorporeal membrane oxygenation on arterial and venous pressure:an in vitro and in vivo study

作　　者：汪君 徐前程 李娟[2] 王涛 仲昌顺 陈群 方可 江海娇 张鹏 鲁卫华 姜小敢 Wang Jun;Xu Qiancheng;Li Juan;Wang Tao;Zhong Changshun;Chen Qun;Fang Ke;Jiang Haijiao;Zhang Peng;Lu Weihua;Jiang Xiaogan(Department of Critical Care Medicine,the First Affiliated Hospital of Wannan Medical College,Yijishan Hospital,Anhui Provincial Clinical Research Center for Critical Respiratory Disease,Wuhu 241000,Anhui,China;Department of Nephrology,Wuhu Hospital Affiliated to East China Normal University(the Second People's Hospital of Wuhu),Wuhu 241000,Anhui,China)

机构地区：[1]皖南医学院第一附属医院(弋矶山医院)重症医学科,安徽省危重症呼吸疾病临床医学研究中心,安徽芜湖241000 [2]华东师范大学附属芜湖医院(芜湖市第二人民医院)肾内科,安徽芜湖241000

出　　处：《中华危重病急救医学》2022年第4期388-393,共6页Chinese Critical Care Medicine

基　　金：安徽省中央引导地方科技发展专项(201907d07050001);安徽省医疗卫生重点专科建设项目(2021-273)。

摘　　要：目的探讨连续性肾脏替代治疗(CRRT)与体外膜肺氧合(ECMO)不同连接方案对CRRT动脉端压力(PA)、静脉端压力(PV)和跨膜压(TMP)的影响,为选择适合的连接方式提供理论依据。方法①体外实验:模拟CRRT与ECMO不同连接方案,根据CRRT动、静脉端与ECMO循环管路不同连接位置分为6种方案:方案A为与氧合器前、氧合器后连接点相连接;方案B为与氧合器后、氧合器前连接点相连接;方案C为与氧合器前、离心泵前连接点相连接;方案D为与氧合器后、离心泵前连接点相连接;方案E为与氧合器前、回输导管连接点相连接;方案F为与氧合器后、回输导管连接点相连接。每套ECMO套包在每个连接方案、不同流量下(2、3、4、5、5.5 L/min)重复测量5次,共6套ECMO套包,测量30次,比较6种方案的PA、PV和TMP。②体内研究:回顾性分析2017年8月至2021年8月在皖南医学院第一附属医院重症医学科使用ECMO联合CRRT治疗并因PA或PV过高而更改方案的患者(由方案A或B更改为方案E或F),观察更改方案前后PA和PV的变化。结果①体外实验结果:在不同ECMO血流量下(2~5.5 L/min),方案A与B、C与D、E与F之间PA比较差异均无统计学意义;其中,方案C、D的PA均最低,方案E、F次之。在不同ECMO血流量下(2~5.5 L/min),方案B的PV均高于方案A;而在3~5.5 L/min的高流量下,方案C与D、E与F之间PV差异均无统计学意义,且方案E和F的PV绝对值均最低。由于方案A、B高流量时部分PA>300 mmHg(1 mmHg≈0.133 kPa),方案C、D高流量时部分PV>350 mmHg,因此方案E、F是较为合理的连接方案。在ECMO血流量为5 L/min和5.5 L/min时,方案C、D的TMP均表现为负值(mmHg;5 L/min:方案C为-29.14±11.42,方案D为-42.45±15.70;5.5 L/min:方案C为-35.75±13.21,方案D为-41.58±15.42),提示存在透析液的反滤过;在不同ECMO血流量(2~5.5 L/min)下,方案A、B、E与F之间TMP差异大多有统计学意义,均数绝对值波动在9.89~49.55 mmHg,均在Objective To investigate the effects of different connection schemes of continuous renal replacement therapy(CRRT)and extracorporeal membrane oxygenation(ECMO)on arterial pressure(PA),venous pressure(PV),and transmembrane pressure(TMP),and to provide a theoretical basis for choosing a suitable connection scheme.Methods①In vitro study:the different connection schemes of CRRT and ECMO were simulated and divided into 6 schemes according to the connection between CRRT and ECMO circuits at different positions.Scheme A:connected to the front and back points of the oxygenator;scheme B:connected to the points behind and in front of the oxygenator;scheme C:connected to the points in front of the oxygenator and in front of the centrifugal pump;scheme D:connected to the points behind the oxygenator and in front of the centrifugal pump;scheme E:connected to the points in front of the oxygenator and the return catheter;scheme F:connected to the points after the oxygenator and the return catheter.Each set of ECMO circuits was measured 5 times under each connection scheme and different flow rates(2,3,4,5,5.5 L/min).Six ECMO circuits for a total of 30 measurements,and the PA,PV,and TMP of the 6 schemes were compared.②In vivo study:the patients who were treated with ECMO combined with CRRT in the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College from August 2017 to August 2021 changed the connection scheme due to high PA or PV(from scheme A or B to scheme E or F)were retrospectively analyzed.The changes of PA and PV before and after changing the scheme were compared.Results①In vitro study results:there was no significant difference in PA between schemes A and B,C and D,E and F under different ECMO blood flow(2-5.5 L/min).The PA of schemes C and D was the lowest,followed by schemes E and F.PV of scheme B was higher than that of scheme A under different ECMO blood flow(2-5.5 L/min).There was no significant difference in PV between schemes C and D,E and F under high ECMO blood flow

关 键 词：连续性肾脏替代治疗 体外膜肺氧合 压力报警 连接方案 联合治疗 

分 类 号：R692.5[医药卫生—泌尿科学]