Frankenfield D C, Reynolds H N, Badellino M M, Wiles C E
Department of Nutrition, RA Cowley Shock Trauma Center, Baltimore, Maryland, USA.
Intensive Care Med. 1995 Dec;21(12):1016-22. doi: 10.1007/BF01700664.
To determine glucose balance during dextrose-free continuous hemodiafiltration with or without dextrose-containing ultrafiltrate replacement fluid and full nutritional support.
Prospective, nonrandomized, observational study.
A 24-bed multiple trauma critical care unit in a level-I trauma center.
Seventeen multiple trauma patients with multiple organ dysfunction syndrome requiring hemodialysis for acute renal failure.
Continuous hemodiafiltration effluent volume and glucose concentration were measured. Study days were classified according to whether dextrose was used in the ultrafiltrate replacement therapy. Use of dextrose in replacement therapy was determined clinically. Parenteral nutrition was not altered for potential glucose absorption from continuous hemodiafiltration. Ultrafiltrate replacement consisted of 5% dextrose in saline on 21 study days (D5YES) and dextrose-free solutions on 54 study days (D5NO).
The D5YES group received 316 +/- 145 g glucose/day from the ultrafiltrate replacement fluid, in addition to glucose in total parenteral nutrition (total glucose intake = 942 +/- 229 g/day in D5YES, 682 +/- 154 g/day in D5NO) (p < 0.05). Glucose loss in continuous hemodiafiltration effluent was 82 +/- 61 g/day in D5YES and 57 +/- 22 g/day in D5NO (P < 0.05), for a net glucose uptake of 8.1 +/- 2.1 mg/kg per min in D5YES and 5.4 +/- 1.5 mg/kg per min in D5NO (p < 0.05). Glucose loss was predictable when dialysate and ultrafiltrate replacement fluids were dextrose-free (R2 = 0.77), but less so when dextrose was used as ultrafiltrate replacement (R2 = 0.47).
Dextrose-free dialysate promotes glucose loss during continuous hemodiafiltration, but the loss is small and predictable. Use of a dextrose-containing ultrafiltrate replacement fluid results in a significant increase in glucose intake without a commensurate increase in glucose loss, and makes glucose loss in effluent less predictable.
确定在无葡萄糖持续血液透析滤过过程中，使用或不使用含葡萄糖的超滤置换液及全营养支持时的葡萄糖平衡情况。
前瞻性、非随机、观察性研究。
一级创伤中心的一个拥有24张床位的多发伤重症监护病房。
17例因急性肾衰竭需要血液透析的多发伤且伴有多器官功能障碍综合征的患者。
测量持续血液透析滤过的流出液量及葡萄糖浓度。根据超滤置换治疗中是否使用葡萄糖对研究日进行分类。置换治疗中葡萄糖的使用根据临床情况确定。肠外营养不因持续血液透析滤过可能的葡萄糖吸收而改变。超滤置换液在21个研究日为含5%葡萄糖的生理盐水（D5YES组），在54个研究日为无葡萄糖溶液（D5NO组）。
D5YES组除了肠外营养中的葡萄糖外，每天从超滤置换液中获得316±145 g葡萄糖（D5YES组总葡萄糖摄入量 = 942±229 g/天，D5NO组为682±154 g/天）（p<0.05）。D5YES组持续血液透析滤过流出液中的葡萄糖损失为82±61 g/天，D5NO组为57±22 g/天（P<0.05），D5YES组葡萄糖净摄取量为8.1±2.1 mg/kg每分钟，D5NO组为5.4±1.5 mg/kg每分钟（p<0.05）。当透析液和超滤置换液均无葡萄糖时，葡萄糖损失是可预测的（R2 = 0.77），但当使用葡萄糖作为超滤置换液时，葡萄糖损失的可预测性较差（R2 = 0.47）。
无葡萄糖透析液在持续血液透析滤过过程中会促进葡萄糖损失，但损失量较小且可预测。使用含葡萄糖的超滤置换液会使葡萄糖摄入量显著增加，而葡萄糖损失没有相应增加，且使流出液中的葡萄糖损失更难以预测。
