Department of Nephrology, VU University Medical Centre, Amsterdam, The Netherlands.
ASAIO J. 2011 Jan-Feb;57(1):48-52. doi: 10.1097/MAT.0b013e318201a599.
In continuous venovenous hemofiltration (CVVH), the delivery of replacement fluid in pre- or postdilution mode remains the subject of controversy. We compared both modes in terms of filter life, dose, and azotemic control. All patients admitted to the intensive care units of a university hospital between November 2004 and December 2006 receiving CVVH and systemic anticoagulation with heparin were retrospectively studied. Thirty-six patients treated by CVVH in predilution and 27 in postdilution mode were studied, with 132 filters in the former and 111 in the latter. The filter life [median ± interquartile range (IQR)] was 24 ± 38 hours and 29 ± 46 hours (p = 0.58) in the pre- and postdilution modes, respectively. Although the fall in creatinine and urea depended on the dose, 19% greater delivered dose in the post- than predilution mode did not impact on azotemic control. In critically ill, heparinized patients on CVVH, filter life and azotemic control are similar in pre- and postdilution modes and underscore the clinical applicability of the predilution mode.
在连续静脉-静脉血液滤过（CVVH）中，前稀释或后稀释模式下的置换液输送仍然存在争议。我们比较了两种模式在滤器寿命、剂量和氮质控制方面的差异。
回顾性分析了 2004 年 11 月至 2006 年 12 月期间在一所大学医院的重症监护病房接受 CVVH 和全身肝素抗凝治疗的所有患者。分别有 36 例患者接受前稀释 CVVH 治疗和 27 例患者接受后稀释 CVVH 治疗，前稀释组有 132 个滤器，后稀释组有 111 个滤器。前稀释组和后稀释组的滤器寿命[中位数±四分位间距（IQR）]分别为 24±38 小时和 29±46 小时（p=0.58）。尽管肌酐和尿素的下降取决于剂量，但后稀释组比前稀释组多 19%的输送剂量并没有影响氮质控制。
在接受 CVVH 治疗的危重症、肝素化患者中，前稀释和后稀释模式的滤器寿命和氮质控制相似，强调了前稀释模式的临床适用性。
