Nagarik Amit P, Soni Sachin S, Adikey Gopal Kishan, Raman Anuradha
Department of Nephrology, Mediciti Hospitals, Hyderabad, Andhra Pradesh, India.
Saudi J Kidney Dis Transpl. 2010 May;21(3):478-83.
Systemic heparinization during continuous renal replacement therapy (CRRT) is associated with disadvantage of risk of bleeding. This study analyses the efficacy of frequent saline flushes compared with heparin anticoagulation to maintain filter life. From January 2004 to November 2007, 65 critically ill patients with acute renal failure underwent CRRT. Continuous venovenous hemodialfiltration (CVVHDF) was performed using Diapact Braun CRRT machine. 1.7% P.D. fluid was used as dialysate. 0.9% NS with addition of 10% Ca Gluconate, Magnesium Sulphate, Soda bicarbonate and Potassium Chloride added sequentially in separate units were used for replacement, carefully monitoring their levels. Anticoagulation of extracorporeal circuit was achieved with unfractionated heparin (250-500 units alternate hour) in 35 patients targeting aPTT of 45-55 seconds. No anticoagulation was used in 30 patients with baseline APTT > 55 seconds and extracorporeal circuit was maintained with saline flushes at 30 min interval. 65 patients including 42 males. Co-morbidities were comparable in both groups. HMARF was significantly more common in heparin group while Sepsis was comparable in both the groups. CRRT parameters were similar in both groups. Average filter life in heparin group was 26 +/- 6.4 hours while it was 24.5 +/- 6.36 hours in heparin free group (P=NS). Patients receiving heparin had 16 bleeding episodes (0.45/patient) while only four bleeding episodes occurred in heparin free group (0.13/patient, P < 0.05). Mortality was 71% in heparin group and 67% in heparin free group. Frequent saline flushes is an effective mode of maintainance of extracorporeal circuit in CRRT when aPTT is already on the higher side, with significantly decreased bleeding episodes.
持续肾脏替代治疗（CRRT）期间进行全身肝素化与出血风险的不利因素相关。本研究分析了与肝素抗凝相比，频繁生理盐水冲洗在维持滤器寿命方面的疗效。2004年1月至2007年11月，65例急性肾衰竭危重症患者接受了CRRT。使用贝朗Diapact CRRT机器进行持续静静脉血液透析滤过（CVVHDF）。1.7%的腹膜透析液用作透析液。0.9%生理盐水依次加入10%葡萄糖酸钙、硫酸镁、碳酸氢钠和氯化钾，分别在不同单元中用于置换，并仔细监测其水平。35例患者使用普通肝素（每小时交替使用250 - 500单位）进行体外循环抗凝，目标活化部分凝血活酶时间（aPTT）为45 - 55秒。30例基线aPTT > 55秒的患者未使用抗凝剂，体外循环通过每隔30分钟用生理盐水冲洗来维持。65例患者中包括42例男性。两组的合并症情况相当。肝素组中高代谢急性肾衰竭（HMARF）更为常见，而两组的脓毒症情况相当。两组的CRRT参数相似。肝素组的平均滤器寿命为26±6.4小时，而无肝素组为24.5±6.36小时（P = 无显著性差异）。接受肝素治疗的患者有16次出血事件（0.45次/患者），而无肝素组仅发生4次出血事件（0.13次/患者，P < 0.05）。肝素组的死亡率为71%，无肝素组为67%。当aPTT已经偏高时，频繁生理盐水冲洗是CRRT中维持体外循环的有效方式，出血事件显著减少。
