盐水冲洗对连续性肾脏替代治疗体外循环寿命及溶质清除的影响  

Effects of normal saline flush on extracorporeal circuit lifespan and solute removal in continuous renal replacement therapy

作　　者：黄显莉 张胜[1] 林丽[1] 王芳[1] 张凌[1] HUANG Xianli;ZHANG Sheng'LIN Li;WANG Fang;ZHANG Ling(Department of Nephrology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Nephrology,Zigong First People's Hospital,Zigong Sichuan 64300,P.R.China)

机构地区：[1]四川大学华西医院肾脏内科,成都610041 [2]自贡市第一人民医院肾脏内科,四川自贡643000

出　　处：《华西医学》2022年第9期1314-1321,共8页West China Medical Journal

基　　金：四川省科学技术厅科技计划项目(2020YFG0105)。

摘　　要：目的探讨生理盐水冲洗及冲洗频率在无抗凝连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)中对体外循环寿命及溶质清除的影响。方法前瞻性收集2021年6月—9月行无抗凝连续性静脉-静脉血液透析滤过(continuous veno-venous hemodiafiltration,CVVHDF)治疗的患者。将纳入患者采用信封随机法分为3组,包括30 min冲水组(每30分钟冲洗体外循环1次)、2 h冲水组(每2小时冲洗体外循环1次)、不冲水组(治疗过程中不冲洗体外循环)。所有患者血管通路采用颈内/股静脉留置双腔导管,均使用Prismaflex V8.0 CRRT机器及匹配的AN69ST-ST150体外循环管路进行治疗,采用CVVHDF模式,血泵速率200 mL/min,置换液及透析液速率均为1000 mL/h,置换液采用前后共同稀释的方式补入。记录体外循环寿命、冲水耽误的治疗时间、整体CRRT治疗时间、实际CRRT治疗时间、实际的治疗时间占比、耽误的每日治疗时间,记录治疗前后小分子溶质的清除效率。结果共纳入患者83例,其中30 min冲水组24例,2 h冲水组30例,不冲水组29例。体外循环寿命及治疗时间各项指标3组间比较差异均有统计学意义(P<0.05)。与2 h冲水组和不冲水组比较,30 min冲水组的体外循环寿命明显缩短、冲水耽误的治疗时间更多、耽误的每日治疗时间最长(P<0.05)。在实际的治疗时间占比方面,不冲水组明显高于30 min冲水组和2 h冲水组(P<0.05),且2 h冲水组也高于30 min冲水组(P<0.05)。3组患者的血尿素氮清除率比较,差异无统计学意义(P=0.570),但血清肌酐清除率比较差异有统计学意义(P=0.020),其中2 h冲水组与30 min冲水组相比,血清肌酐清除率更高(P<0.05)。25例患者在治疗过程中出现了低血压反应。30 min冲水的频率引起体外循环凝血的风险较高(风险比为2.502,P=0.001)。结论对于无抗凝CVVHDF,不使用生理盐水冲洗体外循环,即可获得更长的体外循环寿命和有效治疗时Objective To investigate the effects of normal saline flushing and its frequency on extracorporeal circuit lifespan and solute removal in continuous renal replacement therapy(CRRT)without anticoagulation.Methods Patients undergoing continuous veno-venous hemodiafiltration(CVVHDF)without anticoagulation between June and September 2021 were prospectively collected.The patients were randomly divided into three groups by envelope method,namely 30 min-flushing group(flushing every 30 minutes for extracorporeal circulation),2 h-flushing group(flushing every 2 hours for extracorporeal circulation),and non-flushing group(no flushing for extracorporeal circulation during treatment).All patients were treated with Prismaflex V8.0 CRRT machine and matched AN69ST-ST150extracorporeal circuit,through either femoral or internal jugular venous double-lumen catheter.CVVHDF was adopted,the blood pump rate was 200 mL/min,and the rates of replacement fluid and dialysate were both 1000 mL/h.The replacement fluid was pre-post dilution.Extracorporeal circuit lifespan,treatment time delayed by flushing,overall treatment time of CRRT,actual treatment time of CRRT,proportion of actual treatment time achieved,delayed daily treatment time,and small molecule solute removal efficiency before and after treatment were recorded.Results A total of 83 patients were included,including 24 in the 30 min-flushing group,30 in the 2 h-flushing group,and 29 in the nonflushing group.There were significant differences in the indexes of extracorporeal circuit lifespan and various treatment time indicators among the three groups(P<0.05).Compared with the 2 h-flushing group and the non-flushing group,the30 min-flushing group significantly shortened the extracorporeal circuit lifespan,delayed more treatment time by flushing,and delayed the longest daily treatment time(P<0.05).The proportion of actual treatment time in the nonflushing group was significantly higher than that in the 30 min-flushing group and the 2 h-flushing group(P<0.05),and in the 2 h-flushing

关 键 词：无抗凝 连续性肾脏替代治疗 连续性静脉-静脉血液透析滤过 生理盐水冲洗 体外循环寿命 

分 类 号：R692.5[医药卫生—泌尿科学]