胶体液预冲对接受连续性肾脏替代治疗的重症患者第1小时血压的影响  

Effect of colloid priming on blood pressure in the first hour in critically ill patients receiving continuous renal replacement therapy

作　　者：毛仁丽 刘小兰[1] 王芳[1] 林丽[1] 杨莹莹[1] 王波[3] 张中伟[3] 张凌[1] MAO Renli;LIU Xiaolan;WANG Fang;LIN Li;YANG Yingying;WANG Bo;ZHANG Zhongwei;ZHANG Ling(Department of Nephrology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Nephrology,Guang’an People’s Hospital,Guang’an,Sichuan 638500,P.R.China;Department of Critical Care Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院肾脏内科,成都610041 [2]广安市人民医院肾脏内科,四川广安638500 [3]四川大学华西医院重症医学科,成都610041

出　　处：《华西医学》2025年第3期425-431,共7页West China Medical Journal

基　　金：国家重点研发计划(2023YFC2411800)。

摘　　要：目的探究比较琥珀酰明胶注射液与生理盐水预冲对接受连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的重症患者第1小时血压的影响。方法选取2024年1月—5月在四川大学华西医院重症监护室接受连续性静脉-静脉血液滤过透析治疗的住院患者。将患者按1∶1比例随机分为试验组(胶体液组)和对照组(晶体液组)。胶体液组以琥珀酰明胶注射液为预冲液,双连接方式引血上机,监测并记录上机前10 min及上机后0、1、3、5、10、30、60 min患者的收缩压、舒张压、平均动脉压及心率,上机后0、30、60 min静脉泵入血管加压药的种类及剂量,及第1小时液体出入量。晶体液组以生理盐水为预冲液,其他方法同胶体液组。对比两组患者行CRRT第1小时血压与心率的变化及低血压发生率。结果共纳入患者208例,每组各104例。两组基线资料比较,差异均无统计学意义(P>0.05)。行CRRT开始后3 min晶体液组收缩压低于胶体液组[(122.56±23.82)vs.(129.43±25.46)mm Hg(1 mm Hg=0.133 kPa);t=−2.005,P=0.046]。两组组间的舒张压、平均动脉压、心率在不同时点比较,差异均无统计学意义(P>0.05)。组内比较结果显示,晶体液组的收缩压在上机后1、3、5、10 min均较前下降(P<0.05),舒张压及平均动脉压在上机后3、5、10 min均较前下降(P<0.05);胶体液组血压在上机后不同时点比较,差异均无统计学意义(P>0.05)。晶体液组的心率在上机后10 min高于上机后3 min(P=0.045);胶体液组在上机后60 min低于上机后0 min(P=0.032);两组组内其他时点两两比较差异均无统计学意义(P>0.05)。行CRRT第1小时,晶体液组和胶体液组低血压发生率比较,差异有统计学意义[33例(31.7%)vs.18例(17.3%);χ^(2)=5.845,P=0.016]。结论采用胶体液预冲对改善重症患者行CRRT第1小时血压的下降比晶体液预冲更有优势,且能降低重症患者行CRRT第1小时低血压的发生率。Objective To investigate and compare the effects of succinylated gelatin injection and saline priming on the first hour blood pressure in critically ill patients receiving continuous renal replacement therapy(CRRT).Methods Inpatients who received continuous venous-venous dialysis filtration therapy in the intensive care unit of West China Hospital of Sichuan University between January and May 2024 were selected.The patients were randomly divided into an experimental group(colloidal solution group)and a control group(crystalloid solution group)in a 1∶1 ratio.The colloidal solution group used succinylated gelatin injection as the priming solution,and used the dual connection method to draw blood to the machine.The patient’s systolic blood pressure,diastolic blood pressure,mean arterial pressure and heart rate at 10 minutes before and 0,1,3,5,10,30 and 60 minute after CRRT initiation,the name and dosage of vascular compression drugs pumped intravenously at 0,30 and 60 minutes,and the liquid inlet and outlet in the first hour were monitored and recorded.The crystalloid solution group used normal saline as the priming solution,and the rest of the methods were the same as those of the colloidal solution group.Two groups of patients were compared for changes in blood pressure and heart rate during the first hour of CRRT,as well as the incidence of hypotension.Results A total of 208 patients were included,with 104 cases in each group.There was no significant difference in baseline data between the two groups(P>0.05).At 3 minutes after CRRT,the systolic blood pressure of the crystalloid solution group was lower than that of the colloidal solution group[(122.56±23.82)vs.(129.43±25.46)mm Hg(1 mm Hg=0.133 kPa);t=−2.005,P=0.046].There was no statistically significant difference in diastolic blood pressure,mean arterial pressure,or heart rate between the two groups at different time points(P>0.05).The intra group comparison results showed that the systolic blood pressure of the crystalloid solution group decreased comp

关 键 词：预冲 连续性肾脏替代治疗 血流动力学 低血压 

分 类 号：R47[医药卫生—护理学]