摘要
目的 探讨不同治疗剂量的连续性静脉 -静脉血液透析 (CVVHD)、连续性静脉 -静脉血液滤过(CVVH)及连续性静脉 -静脉血液透析滤过 (CVVHDF)对各种溶质清除率的影响。方法 采用体外试验 ,选用F6 0聚砜膜透析器 ,用DiapactCRRT机分别行模拟CVVHD、前稀释及后稀释CVVH以及前稀释及后稀释CVVHDF ,测定不同透析液和置换液流量下对尿素、肌酐、VitB12 、菊粉的血液侧清除率。结果 CVVHD对各种相对分子质量大小溶质的清除率 ,随着透析液流量的增大而升高。无论在前稀释或后稀释模式 ,CVVH和CVVHDF对各种溶质的清除率均随着置换液量的增大而相应提高 ,其中最高清除率在采用 40 0 0mL/h前稀释模式时达到。和相应置换液输注速度的前稀释模式相比 ,后稀释模式溶质清除率明显高于前稀释模式。在相同透析液和置换液流量情况下 ,CVVHDF模式溶质清除率最高 ,而CVVHD的溶液利用效率较高。结论 体外条件下各种CRRT模式对不同相对分子质量溶质清除率随透析液和置换液流量增加而上升 ,其中前稀释CVVHDF由于可采用更大置换液输注速度 ,可达到最大溶质清除率 ;
Purpose: To evaluate the effects on solute clearance of different continuous renal replacement therapy (CRRT) modes. Methods: An in vitro model using Diapact CRRT system with first-use polysulfone F60 filter was applied to perform continuous veno-venous hemodialysis (CVVHD), pre- and post-dilution continuous veno-venous hemofiltration (CVVH) and continuous veno-venous hemodiafiltration (CVVHDF). Solute clearances of urea, creatinine, vitaminB 12, inulin were determined at different dialysate and ultrafiltrate flow rates. Results: Solute clearances of CVVHD increase with rese of dialysate flow rate. In the cases of CVVH and CVVHDF, solute clearances increase with the rise of substitution flow rate in both pre- and post-dilution modes, with the highest clearance in pre-dilution mode at 4 000 mL/h infusion flow rate. Post-dilution mode always can achieve higher solute clearance compared with corresponding pre-dilution mode. When similar flow rate of dialysate or substitution are used, CVVHDF mode has the highest clearance, while CVVHD appears most effective for solute removal per unit volume of liquid. Conclusions: Cuirrent in vitro study shows that clearances of different molecular weight solute increase with the rise of either dialysate or substitution flow rate, and that pre-dilution CVVHDF can achieve the highest clearance in view of larger infusion flow rate it can realize. Further study should be done to clarify whether these conclusions could be applied in vivo.
出处
《复旦学报（医学版）》
EI
CAS
CSCD
北大核心
2002年第4期268-271,共4页
Fudan University Journal of Medical Sciences
基金
上海市科委优秀学科带头人计划
复旦大学"985"工程资助
