持续肾脏替代治疗中两种稀释枸橼酸盐溶液（15 vs. 18 mmol/L）的比较：碱剩余与肾脏置换液研究
A Comparison between Two Dilute Citrate Solutions (15 vs. 18 mmol/l) in Continuous Renal Replacement Therapy: The Base Excess and Renal Substitution Solution Study.
作者信息
Anstey Chris, Campbell Victoria, Richardson Alexander
机构信息
Department of Intensive Care Medicine, Nambour Hospital, SCHHS, Nambour, Australia.
出版信息
Blood Purif. 2016;42(3):194-201. doi: 10.1159/000446979. Epub 2016 Jun 29.
BACKGROUND/AIMS: The study aimed to compare the changes in biochemistry occurring in patients undergoing continuous renal replacement therapy (CRRT) using 2 trisodium citrate solutions, Baxter hemofiltration fluid containing 18 mmol/l (C18) and Baxter NamSol, a custom manufactured solution containing 15 mmol/l (C15), both delivered as regional citrate anticoagulation (RCA) predilution fluids for hemofiltration.
METHODS
This is a prospective randomized control trial conducted in a major regional adult intensive care unit. Patients were randomized to 1 of 2 RCA fluids. Progress was monitored using a standard daily panel of acid-base and biochemical tests.
RESULTS
Forty-eight patients, 23 C18 and 25 C15, were recruited. In both groups, acidosis resolved within 36 h of institution of CRRT. By day 3, there were significant differences in serum [Na+], standard base excess and serum bicarbonate concentration, all being higher in the C18 group (p < 0.01). By day 5, the PaCO2 had also risen in the C18 group (p = 0.03).
CONCLUSIONS
The C15 solution provided equivalent filter life to the C18 solution but without significant hypernatremia and metabolic alkalosis.
背景/目的：本研究旨在比较使用两种枸橼酸钠溶液进行持续肾脏替代治疗（CRRT）的患者体内发生的生化变化。这两种溶液分别是含18 mmol/L的百特血液滤过液（C18）和定制生产的含15 mmol/L的百特NamSol溶液（C15），二者均作为用于血液滤过的局部枸橼酸盐抗凝（RCA）预稀释液。
方法
这是一项在一家大型地区成人重症监护病房进行的前瞻性随机对照试验。患者被随机分为两种RCA溶液中的一种。使用标准的每日酸碱和生化检测面板监测病情进展。
结果
共招募了48例患者，其中23例使用C18，25例使用C15。两组患者的酸中毒在开始CRRT后36小时内均得到缓解。到第3天，血清[Na+]、标准碱剩余和血清碳酸氢盐浓度存在显著差异，C18组均更高（p < 0.01）。到第5天，C18组的PaCO2也升高了（p = 0.03）。
结论
C15溶液与C18溶液的滤器使用寿命相当，但不会导致明显的高钠血症和代谢性碱中毒。
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