Bunchman T E, Maxvold N J, Kershaw D B, Sedman A B, Custer J R
Division of Pediatric Nephrology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor 48109.
Am J Kidney Dis. 1995 Jan;25(1):17-21. doi: 10.1016/0272-6386(95)90618-5.
Continuous venovenous hemodiafiltration (CVVHD) is not commonly used in pediatric intensive care units due to the lack of suitable equipment needed for this technique of renal replacement therapy (RRT). We have used an adapted hemodialysis machine that includes a blood pump controller, an air leak detector, and a venous pressure monitor over the past year in the pediatric intensive care unit. Blood lines available for hemodialysis were used for CVVHD, limiting the extracorporeal circuit volume to 38 mL, which allows for CVVHD capability in an infant as small as 4.5 kg without a blood-primed circuit. We have compared this experience to previous continuous arteriovenous hemodiafiltration (CAVHD) at our institution. The two groups (CVVHD and CAVHD) were similar in age, weight, blood pressure, and indication for RRT. There was significantly less number of hemofilters used, an improved number of hours per hemofilter, and a significantly less change of RRT modality due to ineffective dialysis (CVVHD 0% v CAVHD 32%) when using CVVHD. Furthermore, an average of 48% less heparin was used in the CVVHD population. We conclude that CVVHD can be safely and effectively carried out in infants and small children with less heparinization, no need for arterial access, and less risk of ineffective RRT.
由于缺乏肾脏替代治疗（RRT）这项技术所需的合适设备，持续静脉-静脉血液透析滤过（CVVHD）在儿科重症监护病房并不常用。在过去一年里，我们在儿科重症监护病房使用了一种经过改装的血液透析机，该机器包括一个血泵控制器、一个空气泄漏探测器和一个静脉压力监测器。用于血液透析的血路被用于CVVHD，将体外循环血量限制在38毫升，这使得体重低至4.5千克的婴儿在无需预充血液回路的情况下也能进行CVVHD。我们将这一经验与我们机构之前的持续动静脉血液透析滤过（CAVHD）进行了比较。两组（CVVHD组和CAVHD组）在年龄、体重、血压和RRT指征方面相似。使用CVVHD时，使用的血液滤过器数量显著减少，每个血液滤过器的使用时长增加，并且由于透析无效导致的RRT模式改变显著减少（CVVHD组为0%，CAVHD组为32%）。此外，CVVHD组平均使用的肝素减少了48%。我们得出结论，CVVHD可以在婴儿和幼儿中安全有效地进行，肝素化程度较低，无需动脉通路，且RRT无效的风险较小。
