Filter run time in CVVH: pre-versus post-dilution and nadroparin versus regional heparin-protamine anticoagulation
Filter run time in CVVH: pre-versus post-dilution and nadroparin versus regional heparin-protamine anticoagulation
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DOI：
10.1159/000083938
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发表时间：
2005-01-01
影响因子：
3
通讯作者：
Boerma, EC
中科院分区：
文献类型：
--
作者：
van der Voort, PHJ;Gerritsen, RT;Boerma, EC
背景/目的：研究不同模式的连续性静脉-静脉血液滤过（CVVH）对滤器运行时间（FRT）的影响。研究方法：我们在两项连续的前瞻性、随机和交叉研究中，对16例和15例危重病期间急性肾衰竭患者进行了研究。研究A比较了前稀释与后稀释，研究B比较了肝素（滤器前）和鱼精蛋白（滤器后）（HP）与那屈肝素（NP）滤器前的局部抗凝。所有CVVH疗程均标准化。通过Wilcoxon秩和检验进行分析。结果：研究A：预稀释期间，稀释后CVVH的中位FRT为45.7小时，而稀释后CVVH的中位FRT为16.1小时（p = 0.005）。前稀释期间的中位肌酐清除率为33 ml/min，后稀释期间为45 ml/min（p = 0.001）。研究B：在NP期间，HP CVVH期间的中位FRT为39.5 vs 12.3 h（p = 0.045）。结论：与后稀释相比，前稀释CVVH导致最大FRT，但血浆肌酐清除率较低。与全身NP抗凝相比，使用肝素-鱼精蛋白的局部抗凝导致FRT显着缩短。版权所有（C）2005 S. Karger AG，巴塞尔。
Background/Aims: To study the effect of different modes of continuous veno-venous haemofiltration (CVVH) on filter run time (FRT). Methods: We studied, in two consecutive prospective, randomised and crossover studies, 16 and 15 patients with acute renal failure during critical illness. Study A compared pre- versus post-dilution, and study B compared regional anticoagulation with heparin (pre-filter) and protamine (post-filter) (HP) versus nadroparin (NP) pre-filter. All CVVH sessions were standardised. Analyses were by Wilcoxon rank sum tests. Results: Study A: During pre- dilution the median FRT was 45.7 vs. 16.1 h in post-dilution CVVH (p = 0.005). The median creatinine clearance during pre- dilution was 33 vs. 45 ml/min in post-dilution (p = 0.001). Study B: During NP, median FRT was 39.5 vs. 12.3 h during HP CVVH (p = 0.045). Conclusions: Pre-dilution CVVH results in the greatest FRT but a lower plasma creatinine clearance compared to post-dilution. Regional anticoagulation with heparin-protamine resulted in a significantly shorter FRT compared to systemic NP anticoagulation. Copyright (C) 2005 S. Karger AG, Basel.