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目的建立犬急性肾衰竭(ARF)模型,观察野战机动式连续性血液净化系统在高原环境(海拔3640m)下工作的稳定性、有效性及安全性。方法选择成年比格犬,外科行双肾切除术制作致ARF模型,应用野战机动式连续性血液净化机行持续静-静脉血液滤过治疗。应用自身对照方法观察治疗前后动物模型生命体征、肝功能、肾功能及血清离子水平变化。检测高原环境下野战机动式连续性血液净化系统的工作性能。结果 6只犬术后24h血尿素氮(BUN)、肌酐(Cr)升高,与术前比较差异有统计学意义(P<0.05),符合ARF诊断标准。3只犬行颈外静脉血液透析用双腔静脉导管置管,3只犬行股静脉置管;5只犬完成全部实验,1只犬因透析管脱落,失血死亡。与治疗前比较,ARF犬治疗后2、4h,平均动脉压、心率、呼吸频率与治疗前比较差异无统计学意义(P>0.05)。血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)及总胆红素(T-Bil)水平与治疗前比较差异无统计学意义(P>0.05)。血清BUN及Cr水平较治疗前下降,差异有统计学意义(P<0.05)。血清K+水平下降,与治疗前比较差异有统计学意义(P<0.05)。治疗过程中无出血、过敏、低血压等并发症发生。野战机动式连续性血液净化系统对异常情况反应敏感、报警迅速。治疗前后系统设置与实际测得的置换液、废液量误差分别为0.273%±0.015%、0.182%±0.014%,差异无统计学意义(P>0.05),符合国家行业标准。结论高原环境下野战机动式连续性血液净化系统工作性能稳定,对ARF治疗安全、有效。
Objective To establish a model of acute renal failure (ARF) in dogs and observe the stability, efficacy and safety of the field mobile continuous blood purification system operating in the plateau environment (3640m above sea level). Methods The adult Beagle dogs were selected. The ARF model was made by surgical double nephrectomy. Continuous field-venous hemofiltration was performed using field-powered continuous blood purifier. The self-control method was used to observe the changes of vital signs, liver function, renal function and serum ion levels in animal models before and after treatment. To test the performance of field mobile continuous blood purification system in high altitude environment. Results The blood urea nitrogen (BUN) and creatinine (Cr) of 6 dogs were significantly higher than those before operation (P <0.05), which met the diagnostic criteria of ARF. Three dogs underwent external jugular vein hemodialysis with double vena cava catheterization and three dogs with femoral vein catheterization. All five dogs completed the experiment, and one dog died of blood loss due to dialysis tube failure. Compared with those before treatment, there was no significant difference in average arterial pressure, heart rate and respiratory rate between two groups (P> 0.05). Serum levels of ALT, AST and T-Bil were not significantly different from those before treatment (P> 0.05). Serum BUN and Cr levels decreased compared with before treatment, the difference was statistically significant (P <0.05). Serum K + levels decreased compared with before treatment was statistically significant (P <0.05). No bleeding, allergies, hypotension and other complications occurred during the treatment. Field mobile continuous blood purification system is sensitive to abnormal conditions, alarm quickly. Before and after treatment, the system settings and actual measurement of replacement fluid and waste fluid errors were 0.273% ± 0.015% and 0.182% ± 0.014%, respectively, with no significant difference (P> 0.05), which met the national industry standards. CONCLUSION: Field operated mobile continuous blood purification system with stable working performance under high altitude environment is safe and effective for the treatment of ARF.