Fealy N, Baldwin I, Johnstone M, Egi M, Bellomo R
Department of Intensive Care, Austin Hospital, Melbourne - Australia.
Int J Artif Organs. 2007 Apr;30(4):301-7. doi: 10.1177/039139880703000404.
To evaluate the efficacy and safety of a regional heparinization and a regional citrate method of anticoagulation in CVVH.
Randomized controlled cross-over study.
Ten critically ill patients with acute renal failure.
ICU of tertiary hospital.
CVVH was performed with pre-filter fluid replacement at 2000 ml/h and a blood flow rate of 150 ml/min. Regional heparinization was by the administration of heparin pre-filter at 1500 IU/h and protamine post-filter at 15 mg/h. Regional citrate anticoagulation was by means of a citrate-based replacement fluid (14 mmol/L) administered pre-dilution.
We studied nine males and one female. The mean age and APACHE II score were 70.5 and 17 respectively. Median circuit life was 13 hours (IQR 9.28) for the regional heparinization method compared to 17 hours (IQR 12,19.5) for the regional citrate method (p=0.77). There were no episodes of bleeding in either group.
Regional heparinization and regional citrate anticoagulation achieve similar circuit life in critically ill patients receiving CVVH.
评估局部肝素化和局部枸橼酸盐抗凝法在连续性静脉-静脉血液滤过（CVVH）中的疗效和安全性。
随机对照交叉研究。
10例急性肾衰竭危重症患者。
三级医院重症监护病房。
以2000 ml/h的预滤器补液量和150 ml/min的血流速度进行CVVH。局部肝素化是通过在滤器前以1500 IU/h的速度给予肝素，并在滤器后以15 mg/h的速度给予鱼精蛋白。局部枸橼酸盐抗凝是通过在预稀释时给予基于枸橼酸盐的置换液（14 mmol/L）来实现。
我们研究了9名男性和1名女性。平均年龄和急性生理与慢性健康状况评分系统（APACHE II）评分分别为70.5和17。局部肝素化法的中位体外循环时间为13小时（四分位间距9.28），而局部枸橼酸盐法为17小时（四分位间距12,19.5）（p = 0.77）。两组均未发生出血事件。
在接受CVVH的危重症患者中，局部肝素化和局部枸橼酸盐抗凝法的体外循环时间相似。
