中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (07): 461-465.doi: 10.3969/j.issn.1671-4091.2018.07.007

• 临床研究 • 上一篇    下一篇

一种“二阶段补钙模型”在RCA-CVVH 中的临床应用

庄峰1,俞雯艳1,马帅1,卢建新1,陆伟1,丁峰1   

  1. 1.  上海交通大学医学院附属第九人民医院肾脏科，危重肾脏病研究室
  • 收稿日期:2018-01-15 修回日期:2018-05-14 出版日期:2018-07-12 发布日期:2018-07-12
  • 通讯作者: 丁峰 dingfeng@sjtu.edu.cn E-mail:teddy_zf@163.com
  • 基金资助:

    国家自然科学基金(编号：81270850,81470990)
    上海市科委科技支撑项目(编号：17441904200)
    上海市浦东新区卫计委联合攻关项目(编号：PW2015D-4)
    上海交通大学医工交叉重点项目(YG2014ZD06)
    上海交通大学医学院附属第九人民医院临床研究助推计划(编号：JYLJ007)

Clinical application of the two-stage calcium supplement model in continuous venous-venous hemofiltration under regional citrate anticoagulation (RCA-CVVH)

  • Received:2018-01-15 Revised:2018-05-14 Online:2018-07-12 Published:2018-07-12

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摘要： 【摘要】目的基于“二阶段补钙模型”建立补钙方程并加以临床实践，以更加简便、有效的推广枸橼酸抗凝技术。方法选取上海交通大学医学院附属第九人民医院行肾脏替代治疗的患者共50 人、共进行有效局部枸橼酸抗凝下连续静脉静脉血液滤过(continuous venous-venous hemofiltration under regional citrate anticoagulation，RCA-CVVH)计156 例次，其中连续静脉静脉血液滤过(continuous venous-venous hemofiltration，CVVH)采用前稀释模式、低碱无钙置换液，置换液速度4L/h，治疗时间6～8h。循环管路动脉端输注血液保存液-a(anticoagulant citrate dextrose solution-a，ACDa)，枸橼酸以4～4.5mmol/L 血浆流量速度输入；静脉端补充5%氯化钙，补钙速率利用“二阶段补钙模型”计算得出。在CVVH 治疗过程中观察滤器凝血程度，并且每2～3h 用iStat 生化仪监测动脉端、滤器前的游离钙水平，留取动脉端1ml血液检测总钙水平，并计算得出动脉端总钙/离子钙水平。结果在156例CVVH中，RCA抗凝有效占总次数的96.79%(151/156), 抗凝效果理想；90.4%的管路滤器前离子钙浓度在0.2～0.4mmol/L，均在目标范围内；90.5%的管路动脉端离子钙监测结果均在1.0～1.2mmol/L ；97.14%的体内总钙与离子钙比值结果＜2.5，无枸橼酸蓄积倾向；熟练应用“二阶段补钙方程”可明显减少离子钙监测频率，减少人力、物力、财力。结论二阶段补钙模型有效性、安全、简便，具有良好的临床实用性。

关键词: 枸橼酸抗凝, 二阶段补钙, 肾脏替代治疗

Abstract: 【Abstract】Objective To establish the calcium supplement equation based on the two-stage calcium supplement model in order to promote the local citrate anticoagulation method simply and effectively used in clinical practice. Methods Fifty patients with renal replacement therapy were recruited in this study. They were effectively treated with continuous venous-venous hemofiltration under regional citrate anticoagulation (RCACVVH) for a total of 156 times. The CVVH adopted pre-dilution mode using the low-base and calcium-free replacement solution with the speed of 4L/h and lasted 6-8 hours. The anticoagulant citrate dextrose solution-a (ACD-a) was infused in arterial end, and the citrate was fed at 4.0～4.5 mmol/L plasma flow. The venous end was supplemented with 5% calcium chloride, and the calcium supplement rate was calculated by the "twostage calcium supplement model". The degree of coagulation in filter was observed during CVVH treatment. The calcium ion level at the arterial end and before the filter was measured by the iState biochemical analyzer every 2～3 hours, and the total calcium level was measured at the arterial end. The ratio of total calcium/ion calcium was then calculated. Results In the 156 times of CVVH, the percentage of effective anticoagulation using RCA was 96.79% (151/156), which is the ideal result. The calcium ion concentration of 0.2～0.4 mmol/L in ore-filter was found in 90.4% CVVH sessions, which approaches the target range. The calcium ion concentration of 1～1.2 mmol/L in arterial port was found in 90.5% CVVH sessions. The ratio of total calcium/ion calcium in the body was <2.5, without citrate accumulation. Skilled application of the two-stage calcium supplement equation can significantly reduce the frequency of calcium ion monitoring, and save the manpower, material and financial resources. Conclusions The two-stage calcium supplement model is effective, safe and simple. It is useful in hemodialysis.