Egi M, Naka T, Bellomo R, Cole L, French C, Trethewy C, Wan L, Langenberg C C, Fealy N, Baldwin I
Department of Intensive Care and Department of Medicine, Austin Hospital and Melbourne University, Melbourne - Australia.
Int J Artif Organs. 2005 Dec;28(12):1211-8. doi: 10.1177/039139880502801203.
To assess the safety and efficacy of two different commercial citrate containing pre-filter replacement fluids during continuous veno-venous hemofiltration (CVVH) in patients with frequent filter clotting.
Four intensive care units.
Sixty-three critically ill patients with acute renal failure (ARF).
Prospective observational study.
We used a commercial citrate fluid (citrate: 11 mmol/L -fluid A) as predilution replacement for CVVH. We then changed to a new commercial citrate fluid (citrate: 14 mmol/L-fluid B) as replacement fluid and performed statistical comparisons. Replacement fluid rate was fixed at 2,000 ml/hour.
Filter life was 12.2 hour with fluid A compared with 17.1 hour with fluid B on average (p=0.0001). Mean post filter ionized calcium concentration was 0.52 mmol/L with fluid A compared with 0.40 mmol/L with fluid B (p<0.0001). Citrate intolerance led to cessation of treatment in one patient with fluid A and one patient with fluid B. Overall ionized calcium levels were higher (A: 1.18 vs B: 1.13 mmol/L; p<0.0001) and bicarbonate was lower (A: 22.4 vs B: 24.5 mmol/L; p<0.0001) during treatment with fluid A. Alkalemia was seen in 10 patients treated with fluid A and 16 patients treated with fluid B (NS).
We have developed a simple approach to regional citrate anticoagulation for CVVH using a commercial citrate-containing fluid as replacement fluid. Increasing citrate concentration from 11 to 14 mmol/L increased filter life while maintaining relative safety and simplicity.
评估两种不同的含枸橼酸盐的商品化预滤器置换液在频繁滤器凝血患者的持续静脉-静脉血液滤过（CVVH）中的安全性和有效性。
四个重症监护病房。
63例急性肾衰竭（ARF）的危重症患者。
前瞻性观察研究。
我们使用一种商品化枸橼酸盐溶液（枸橼酸盐：11 mmol/L - 溶液A）作为CVVH的预稀释置换液。然后更换为一种新的商品化枸橼酸盐溶液（枸橼酸盐：14 mmol/L - 溶液B）作为置换液并进行统计学比较。置换液速率固定为2000毫升/小时。
使用溶液A时滤器寿命平均为12.2小时，而使用溶液B时为17.1小时（p = 0.0001）。使用溶液A时滤器后平均游离钙离子浓度为0.52 mmol/L，而使用溶液B时为0.40 mmol/L（p < 0.0001）。枸橼酸盐不耐受导致使用溶液A的1例患者和使用溶液B的1例患者停止治疗。使用溶液A治疗期间总体游离钙离子水平较高（A：1.18 vs B：1.13 mmol/L；p < 0.0001），碳酸氢盐水平较低（A：22.4 vs B：24.5 mmol/L；p < 0.0001）。使用溶液A治疗的10例患者和使用溶液B治疗的16例患者出现碱血症（无统计学差异）。
我们开发了一种简单的方法，使用含枸橼酸盐的商品化溶液作为置换液进行CVVH的局部枸橼酸盐抗凝。将枸橼酸盐浓度从11 mmol/L提高到14 mmol/L可延长滤器寿命，同时保持相对的安全性和简便性。
