Bellomo R, Teede H, Boyce N
Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
Intensive Care Med. 1993;19(6):329-32. doi: 10.1007/BF01694706.
To compare and contrast different heparin regimens for extracorporeal circuit anticoagulation in patients receiving acute continuous hemodiafiltration (ACHD).
Prospective controlled randomized comparisons of the following regimens: 1) Low dose (500 IU/h) pre-filter heparin versus regional anticoagulation in patients on continuous arteriovenous hemodiafiltration (CAVHD) via A-V shunt. 2) Low dose pre-filter heparin versus no anticoagulation in patients receiving CAVHD via femoral cannulae. 3) Low dose pre-filter heparin versus regional anticoagulation in patients on continuous veno-venous hemodiafiltration (CVVHD). 4) An assessment of the consequences of the use of no anticoagulant in patients predicted to be at high risk of hemorrhagic complications on treatment with CVVHD.
University Teaching Hospital ICU.
64 ICU patients with acute renal failure.
Haemofilter survival during shunt CAVHD was significantly prolonged by the use of regional anticoagulation compared to the use of low dose heparin (mean filter survival: 57.1 h versus 42.9 h; p < 0.05). In CAVHD using femoral cannulae, no significant differences in haemofilter survival were found between anticoagulation with low dose heparin and the use of no anticoagulant (mean filter survival: 55 h versus 52.5 h; NS). During CVVHD, regional anticoagulation compared to low dose heparin produced a trend towards prolonged filter life which was, however, not statistically significant (mean filter survival: 40.5 h versus 31.4 h; NS). In patients assessed to be at high risk of bleeding, CVVHD without anticoagulation provided a mean filter survival of 40.9 h (95% CI 27-54.8 h).
Regional anticoagulation leads to longer filter survival than low dose heparin in shunt CAVHD. A regimen of no anticoagulation during femoral CAVHD leads to a filter life similar to that of low dose heparinization. During CVVHD, regional anticoagulation and low dose heparin are associated with similar filter survival times. In patients assessed to be at high risk of bleeding, treatment with CVVHD without anticoagulation results in adequate filter survival.
比较和对比接受急性连续性血液透析滤过（ACHD）患者体外循环抗凝的不同肝素方案。
对以下方案进行前瞻性对照随机比较：1）连续动静脉血液透析滤过（CAVHD）经动静脉分流患者，低剂量（500 IU/h）滤器前肝素与局部抗凝的比较。2）经股静脉置管接受CAVHD患者，低剂量滤器前肝素与不抗凝的比较。3）连续静脉-静脉血液透析滤过（CVVHD）患者，低剂量滤器前肝素与局部抗凝的比较。4）评估预计有出血并发症高风险的患者在接受CVVHD治疗时不使用抗凝剂的后果。
大学教学医院重症监护病房。
64例急性肾衰竭的重症监护病房患者。
与使用低剂量肝素相比，在分流CAVHD期间使用局部抗凝可显著延长血液滤过器的存活时间（平均滤器存活时间：57.1小时对42.9小时；p<0.05）。在使用股静脉置管的CAVHD中，低剂量肝素抗凝与不使用抗凝剂之间在血液滤过器存活时间上无显著差异（平均滤器存活时间：55小时对52.5小时；无显著性差异）。在CVVHD期间，与低剂量肝素相比，局部抗凝使滤器寿命有延长趋势，但无统计学意义（平均滤器存活时间：40.5小时对31.4小时；无显著性差异）。在评估有出血高风险的患者中，不抗凝的CVVHD平均滤器存活时间为40.9小时（95%可信区间27 - 54.8小时）。
在分流CAVHD中，局部抗凝比低剂量肝素导致更长的滤器存活时间。股静脉CAVHD期间不抗凝方案导致的滤器寿命与低剂量肝素化相似。在CVVHD期间，局部抗凝和低剂量肝素的滤器存活时间相似。在评估有出血高风险的患者中，不抗凝的CVVHD治疗可实现足够的滤器存活时间。
