不同剂量持续静脉-静脉血液滤过对危重症患者血浆乳酸的影响

Effects of different doses in continuous veno-venous hemofiltration on plasma lactate in critically ill patients.

作者信息

Liu Yongjun, Ouyang Bin, Chen Juan, Chen Minying, Ma Jie, Wu Jianfeng, Huang Shunwei, Li Lifen, Liu Zimeng, Guan Xiangdong

机构信息

Department of Surgical Intensive Care Unit, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.

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出版信息

Chin Med J (Engl). 2014;127(10):1827-32.

PMID:24824239

Abstract

BACKGROUND

Many studies have shown that continuous renal replacement therapy (CRRT) could clean lactate and treat the hyper-lactatemia. On the contrary, some other studies found that filter lactate clearance only accounted for a very small part of total lactate clearance and the hemofilter's contribution to the overall lactate clearance was negligible. The objective of this study was to evaluate the effects of various doses of continuous veno-venous hemofiltration (CVVH) on plasma lactate elimination in critically ill patients.

METHODS

Patients were divided into three groups according to their incipient plasma lactate concentration. Group A: lactate ≤ 2 mmol/L, group B: lactate 2-5 mmol/L, group C: lactate ≥ 5 mmol/L. Three different doses (20 ml × kg(-1)× h(-1), 35 ml × kg(-1)× h(-1) and 45 ml × kg(-1)× h(-1)) of CVVH were applied to critically ill patients who experiencing CVVH. The concentrations of plasma lactate in pre-(A), post-dialyzer (V) sites and ultrafiltrate were measured after each dosage of CVVH was carried out for 30 minutes. Rate of lactate clearance by the filter (RLC) and filter lactate clearance (FLC) and Lactate-Sieving Coefficient (LSC) were calculated under different circumstances, including different doses of CVVH and different incipient lactate levels.

RESULTS

Fifteen patients were enrolled and 104 blood samples were drawn and lactate concentrations were measured in this study. RLC was found increased ((9.36 ± 9.73) mmol/h, (13.92 ± 12.56) mmol/h and (16.52 ± 12.71) mmol/h, P < 0.05 respectively) with the dose of CVVH increased. RLC was also increased ((3.46 ± 1.46), (10.38 ± 5.50) and (24.53 ± 14.69) mmol/h, P < 0.05 respectively) with the incipient lactate increased. FLC was increased ((1.95 ± 0.63), (2.95 ± 0.74) and (3.45 ± 0.54) L/h, P < 0.05 respectively) with the dose of CVVH increased. There was no significant difference of LSC in different doses of CVVH and different incipient lactate levels.

CONCLUSIONS

Plasma lactate can be eliminated by CVVH and different doses of CVVH affect the rate of lactate clearance in critically ill patients.

摘要

背景

许多研究表明，持续肾脏替代治疗（CRRT）能够清除乳酸并治疗高乳酸血症。相反，其他一些研究发现滤器乳酸清除率仅占总乳酸清除率的很小一部分，且血液滤过器对整体乳酸清除的贡献可忽略不计。本研究的目的是评估不同剂量的持续静静脉血液滤过（CVVH）对重症患者血浆乳酸清除的影响。

方法

根据患者初始血浆乳酸浓度将其分为三组。A组：乳酸≤2 mmol/L，B组：乳酸2 - 5 mmol/L，C组：乳酸≥5 mmol/L。对接受CVVH的重症患者应用三种不同剂量（20 ml×kg⁻¹×h⁻¹、35 ml×kg⁻¹×h⁻¹和45 ml×kg⁻¹×h⁻¹）的CVVH。在每次CVVH治疗30分钟后，测量透析前（A）、透析后（V）部位及超滤液中的血浆乳酸浓度。计算不同情况下（包括不同剂量的CVVH和不同初始乳酸水平）滤器乳酸清除率（RLC）、滤器乳酸清除量（FLC）和乳酸筛系数（LSC）。

结果

本研究共纳入15例患者，采集104份血样并测量乳酸浓度。发现随着CVVH剂量增加，RLC升高（分别为(9.36 ± 9.73) mmol/h、(13.92 ± 12.56) mmol/h和(16.52 ± 12.71) mmol/h，P < 0.05）。随着初始乳酸水平升高，RLC也升高（分别为(3.46 ± 1.46)、(10.38 ± 5.50)和(24.53 ± 14.69) mmol/h，P < 0.05）。随着CVVH剂量增加，FLC升高（分别为(1.95 ± 0.63)、(2.95 ± 0.74)和(3.45 ± 0.54) L/h，P < 0.05）。不同剂量的CVVH和不同初始乳酸水平下，LSC无显著差异。