Macias W L, Mueller B A, Scarim S K, Robinson M, Rudy D W
Nephrology Section, Indiana University School of Medicine, Indianapolis 46202.
Am J Kidney Dis. 1991 Oct;18(4):451-8. doi: 10.1016/s0272-6386(12)80113-2.
Continuous venovenous hemofiltration (CVVH) has been used as an alternative to continuous arteriovenous hemofiltration (CAVH) and hemodiafiltration (CAVHD) in the management of critically ill patients with acute renal failure. This report describes our experience with the first 25 patients treated with CVVH at our institution. Vascular access was obtained through a single dual-lumen venous catheter. A blood pump was used to provide ultrafiltration pressure. An ultrafiltrate pump was incorporated to ensure predictable ultrafiltrate production rates. Safety features in the extracorporeal circuit included a venous drip chamber with bubble detector and an in-line pressure monitor. CVVH was initiated by a nephrologist and dialysis nurse and was maintained by the intensive care unit (ICU) nursing staff. Fifteen females and 10 males received CVVH therapy for a total of 193.5 days (average, 7.7 +/- 10.3 days; range, 0.5 to 48 days). Four of the 25 patients (16%) survived and were discharged from the hospital. Four additional patients (16%) survived the acute phase of their illness, but died from complications of their primary disease before discharge from the hospital. The mean weight change during CVVH was -7.9 +/- 7.0 kg (range, -26.5 to +2.9 kg). Metabolic waste products and electrolytes were adequately controlled by CVVH in all but one hypercatabolic patient. The mean heparin dose required was 6.5 +/- 4.2 U/kg/h and was adjusted to prevent filter clotting rather than to achieve a predetermined activated partial thromboplastin time (PTT). The median PTT was 35.8 seconds (range, 22.0 to 100; control, 19.5 to 29.5 seconds). Four episodes of volume-responsive hypotension occurred during the 193.5 treatment days. Only one patient experienced a hemorrhagic complication during CVVH. No patient experienced a complication related to vascular access. Twelve of 111 total hemofilters were changed because of clot formation. CVVH was well tolerated by patients and managed efficiently by the ICU nursing staff.(ABSTRACT TRUNCATED AT 250 WORDS)
持续静静脉血液滤过（CVVH）已被用作连续性动静脉血液滤过（CAVH）和连续性动静脉血液透析滤过（CAVHD）的替代方法，用于治疗急性肾衰竭的危重症患者。本报告描述了我们机构首批25例接受CVVH治疗患者的经验。通过单根双腔静脉导管建立血管通路。使用血泵提供超滤压力。配备超滤泵以确保可预测的超滤率。体外循环的安全装置包括带气泡探测器的静脉滴注室和在线压力监测器。CVVH由肾病科医生和透析护士启动，由重症监护病房（ICU）护理人员维持。15名女性和10名男性接受了CVVH治疗，共193.5天（平均7.7±10.3天；范围0.5至48天）。25例患者中有4例（16%）存活并出院。另外4例患者（16%）在疾病急性期存活，但在出院前死于原发性疾病并发症。CVVH期间的平均体重变化为-7.9±7.0 kg（范围-26.5至+2.9 kg）。除1例高分解代谢患者外，CVVH对所有患者的代谢废物和电解质均能进行充分控制。所需肝素平均剂量为6.5±4.2 U/kg/h，并进行调整以防止滤器凝血，而非达到预定的活化部分凝血活酶时间（PTT）。PTT中位数为35.8秒（范围22.0至100；对照19.当患者耐受良好，由ICU护理人员有效管理。（摘要截短至250字） 5至29.5秒）。在193.5个治疗日期间发生了4次容量反应性低血压发作。CVVH期间只有1例患者出现出血并发症。没有患者出现与血管通路相关的并发症。总共111个血液滤器中有12个因凝血而更换。CVVH对
