Department of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, U nemocnice 2, Prague 2, 120 00, Czech Republic.
J Crit Care. 2013 Feb;28(1):87-95. doi: 10.1016/j.jcrc.2012.06.003. Epub 2012 Aug 27.
To determine bioenergetic gain of 2 different citrate anticoagulated continuous hemodiafiltration (CVVHDF) modalities and a heparin modality.
We compared the bio-energetic gain of citrate, glucose and lactate between 29 patients receiving 2.2% acid-citrate-dextrose with calcium-containing lactate-buffered solutions (ACD/Ca(plus)/lactate), 34 on 4% trisodium citrate with calcium-free low-bicarbonate buffered fluids (TSC/Ca(min)/bicarbonate), and 18 on heparin with lactate buffering (Hep/lactate).
While delivered CVVHDF dose was about 2000 mL/h, total bioenergetic gain was 262 kJ/h (IQR 230-284) with ACD/Ca(plus)/lactate, 20 kJ/h (8-25) with TSC/Ca(min)/bicarbonate (P < .01) and 60 kJ/h (52-76) with Hep/lactate. Median patient delivery of citrate was 31.2 mmol/h (25-34.7) in ACD/Ca(plus)/lactate versus 14.8 mmol/h (12.4-19.1) in TSC/Ca(min)/bicarbonate groups (P < .01). Median delivery of glucose was 36.8 mmol/h (29.9-43) in ACD/Ca(plus)/lactate, and of lactate 52.5 mmol/h (49.2-59.1) in ACD/Ca(plus)/lactate and 56.1 mmol/h (49.6-64.2) in Hep/lactate groups. The higher energy delivery with ACD/Ca(plus)/lactate was partially due to the higher blood flow used in this modality and the calcium-containing dialysate.
The bioenergetic gain of CVVHDF comes from glucose (in ACD), lactate and citrate. The amount substantially differs between modalities despite a similar CVVHDF dose and is unacceptably high when using ACD with calcium-containing lactate-buffered solutions and a higher blood flow. When calculating nutritional needs, we should account for the energy delivered by CVVHDF.
确定两种不同的柠檬酸盐抗凝连续血液透析滤过（CVVHDF）模式和肝素模式的生物能量增益。
我们比较了 29 名接受含钙乳酸缓冲液（ACD/Ca（plus）/lactate）的 2.2% 柠檬酸葡萄糖酸钙和 34 名接受无钙低碳酸氢盐缓冲液（TSC/Ca（min）/bicarbonate）的 4% 柠檬酸钠的患者之间的生物能量增益葡萄糖和乳酸，以及 18 名接受乳酸缓冲肝素（Hep/lactate）的患者。
虽然提供的 CVVHDF 剂量约为 2000 mL/h，但总生物能量增益为 262 kJ/h（IQR 230-284），ACD/Ca（plus）/lactate 为 20 kJ/h（8-25），TSC/Ca（min）/bicarbonate 为 60 kJ/h（52-76）与 Hep/lactate。ACD/Ca（plus）/lactate 组中柠檬酸盐的中位患者剂量为 31.2 mmol/h（25-34.7），而 TSC/Ca（min）/bicarbonate 组中柠檬酸盐的中位剂量为 14.8 mmol/h（12.4-19.1）（P <.01）。ACD/Ca（plus）/lactate 中葡萄糖的中位输送量为 36.8 mmol/h（29.9-43），ACD/Ca（plus）/lactate 中乳酸的中位输送量为 52.5 mmol/h（49.2-59.1），Hep/lactate 组中乳酸的中位输送量为 56.1 mmol/h（49.6-64.2）。ACD/Ca（plus）/lactate 中较高的能量输送部分是由于该模式下使用的较高血流和含钙透析液。
CVVHDF 的生物能量增益来自葡萄糖（在 ACD 中）、乳酸和柠檬酸盐。尽管 CVVHDF 剂量相似，但不同模式之间的输送量有很大差异，当使用含钙乳酸缓冲液和较高血流的 ACD 时，输送量过高。在计算营养需求时，我们应该考虑 CVVHDF 输送的能量。
