中国血液净化

›› 2005, Vol. 4 ›› Issue (8): 447-450.

• 论著 • 上一篇    下一篇

高容量血液滤过治疗置换液配方初探

滕 杰 陈利明 邹建洲 方 艺 钟一红 吉 俊 章晓燕 傅辰生 丁小强   

  1. 200032 上海，复旦大学附属中山医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-08-12 发布日期:2005-08-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-08-12 Published:2005-08-12

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摘要： 目的 探讨高容量血液滤过治疗时置换液的合理配制问题。方法 应用高容量血液滤过治疗复旦大学附属中山医院2002年1月～2003年12月，37例MODS患者，前瞻性观察治疗前后患者血流动力学、肝肾功能、血电解质及酸碱平衡的变化。置换液配方生理盐水2500ml、注射用水1000ml、50%葡萄糖水10ml、5%NaHCO3 250ml、10%KCl 12ml、10%葡萄糖酸钙40ml、25%MgSO4 3ml。以前稀释方式输入，采用低分子肝素抗凝。结果 37例患者共治疗171例次，血液滤过治疗过程中患者心率、平均动脉压、中心静脉压等血流动力学参数稳定，血钾、钠、氯、钙、磷、镁、ALT、AST、白蛋白、球蛋白、血糖等生化指标治疗前后稳定。血pH、PCO2、HCO3-等酸碱指标治疗前后稳定，PO2 、BE治疗后较治疗前显著改善。治疗后TB、CB、Cr等指标则均较治疗前显著改善。结论 本院自制置换液配制简单、离子浓度准确，可安全应用于高容量血液滤过治疗。

关键词: 高容量血液滤过, 置换液, 配方

Abstract: Objective To study the optimal composition of the substitution fluid in high volume hemofiltration (HVHF). Methods Thirty-seven patients with MODS received 171 HVHF treatments. Blood samples were collected from the patients, biochemical parameters and hemodynamic parameters were tested before and after the treatment. Those parameters were also monitored during the whole session of each treatment. Our substitution contained 2500ml of saline, 1000ml of distilled water, 10ml (50%) of glucose solution, 250ml (5%) of NaHCO3, 12ml (10%) of KCl,40ml(10%) of calcium gluconate and 3ml (25%) of MgSO4. The fluids were administered by pre-dilution mode and low molecular weight heparin (LMWH) was available for anticoagulation. Results During each session of HVHF, patients?hemodynamic parameters such as heart rate (HR), mean artery pressure (MAP) and central veneus pressure (CVP) were steady. There were no significant changes of serum ALT, AST, albumin, globulin, glucose and electrolytes level after one session. Blood -gas analysis showed that under the treatment, patients?arterial pH, PCO2 and HCO3 were maintained in the normal range, while PO2 and base excess (BE) had got marked improvement. There had been a significant improvement on patients?hepatic function and renal function after the treatments with the reduction of serum TB, CB and creatinine.Conclusions Our prescription for the substitution fluid is easy to make. With the precise calculation of the ionic concentration, the substitution fluids made by ourselves can be applied safely for HVHF treatments.

Key words: The substitution fluid, Composition

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