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目的 通过前稀释持续静脉-静脉血液滤过(CVVH)治疗的体外实验,研究血流量和超滤率在前稀释模式CVVH时对溶质清除的影响。 方法 建立等容、前稀释CVVH体外实验装置,置换液流最(Qs)等于超滤率(Quf),采用高通透性膜血滤器,测定不同Quf和血流量时尿素、肌酐的滤器清除率(Kf)和患者获得的清除率(Kt)以及溶质的筛系数(SC)。每个Qb和Quf组合重复实验3次(n=3)。结果 该实验条件下,尿素、肌酐SC接近1.00,滤器清除率(Kf)等于SC;Qb或Quf增加,其SC无明显变化。在前稀释模式时,CVVH患者获得的溶质清除率(K(?))比滤器的清除率(Kf)低,增加Qb可使患者获得的清除率和清除效率增加。增加血流量的这种作用在超滤率=100 mL/min时尤其显著。结论 CVVH在前稀释时,小分子溶质Kf与Quf基本相等,Quf可作为治疗剂量的指标。在前稀释时,患都K(?)低于Kf增加血流量(Qb)可显著提高治疗效率,特别是在大剂量前稀释CVVH治疗时。
Objective To investigate the effects of blood flow and ultrafiltration rates on solute clearance in a pre-dilution mode of CVVH through in vitro experiments of pre-dilution continuous veno-venous hemofiltration (CVVH). Methods The isovolumetric and pre-dilution CVVH experimental apparatus were set up. The Qs of the replacement fluid was equal to the ultrafiltration rate (Quf). The membrane permeability of urea and creatinine (Kf) and patient clearance (Kt) as well as solute sieve index (SC). Each Qb and Quf combination was repeated 3 times (n = 3). Results Under the experimental conditions, urea and creatinine SC were close to 1.00, and the filter clearance (Kf) was equal to SC; while Qb or Quf increased, SC did not change significantly. In the pre-dilution mode, patients with CVVH achieved a lower solute clearance (K (?)) Than the filter clearance (Kf) and an increase in Qb resulted in increased clearance and clearance efficiency for patients. This effect of increasing blood flow is especially pronounced at ultrafiltration rates = 100 mL / min. Conclusion When CVVH was pre-diluted, Kf of small molecule solute was almost equal to that of Quf, and Quf could be used as an indicator of therapeutic dose. At pre-dilution, increasing K (?) Below Kf and increasing blood flow (Qb) significantly increased the efficiency of treatment, especially when CVVH was diluted before high doses.