摘要
目的：研究儿童连续性静脉-静脉血液滤过（ CVVH）时局部应用枸橼酸抗凝（ RCA）的适合剂量,并探讨其疗效和安全性。方法研究对象为2012年10月至2014年7月珠江医院儿科重症监护室（ PICU）接受CVVH且应用RCA的患儿66例,予枸橼酸-葡萄糖抗凝溶液A（ ACD-A）配方抗凝。患儿按体质量分为4组：≤10 kg组（Ⅰ组）、20 kg≥体质量〉10 kg组（Ⅱ组）、30 kg≥体质量〉20 kg组（Ⅲ组）、〉30 kg组（Ⅳ组）。每组随机接受2种不同剂量的ACD-A：ACD-A速度（mL/h）=0.75×血流量（BFR）（mL/min）（A剂量）和ACD-A=1.5×BFR（B剂量）。监测滤器持续时间、体内和体外循环的活化部分凝血活酶时间（APTT）、体内离子钙、体外循环离子钙、体内总钙、血尿素氮（ BUN）、肌酐（ Cr）、丙氨酸氨基转移酶（ ALT）、天门冬氨酸氨基转移酶（ AST）、血清pH值、钠（ Na＋）水平、碳酸氢根（ HCO3-）水平等参数,进行统计分析。结果 RCA对不同体质量组患儿APTT、BUN及Cr的清除及ALT、AST的影响差异无统计学意义（P均〉0.05）。Ⅰ组B剂量pH值显著高于Ⅰ组A剂量pH,差异有统计学意义（F=7.384,P=0.015）,Ⅱ组B剂量pH值显著高于Ⅱ组A剂量pH值,差异有统计学意义（F=4.492,P=0.046）,Ⅰ组B剂量HCO3-水平显著高于Ⅰ组A剂量HCO3-水平,差异有统计学意义（F=7.735,P=0.013）,Ⅱ组B剂量HCO3-水平显著高于Ⅱ组A剂量HCO3-水平,差异有统计学意义（F=4.644,P=0.042）,Ⅲ组B剂量滤器持续时间显著高于Ⅲ组A剂量,差异有统计学意义（t=-3.147,P=0.016）,Ⅳ组B剂量滤器持续时间显著高于Ⅳ组A剂量,差异有统计学意义（t=-6.342,P=0．000）。结论儿童CVVH应用RCA安全有效,不同体质量应用不同ACD-A抗凝速度能减少代谢性碱中毒和增强局部抗凝的效果。
Objective To study the reasonable doses, efficacy and safety of regional citrate anticoagulation （RCA） for continuous veno-venous hemofiltration（CVVH） in children. Methods There were 66 patients hospi-ta-lized in Pediatric Intensive Care Unit of Zhujiang Hospital,Southern Medical University treated with RCA-CVVH that were recruited in the study from October 2012 to July 2014. The patients were divided into 4 groups according to their weight：≤10 kg（ group Ⅰ） ,20 kg≥weight〉10 kg（ group Ⅱ） ,30 kg≥weight〉20 kg（ group Ⅲ） ,〉30 kg（ groupⅣ）,and each group randomly received 2 different doses of anticoagulant acid citrate dextrose formula A（ACD-A）：ACD-A（mL/h）=0. 75×blood flow rate（BFR）（mL/min）（A dose） and ACD-A=1. 5×BFR（B dose）. Data of hemo-filter duration, activated partial thromboplastin time（ APTT） （ systemic and circuit） , ionized calcium（ Ca2＋） （ systemic and circuit）, blood urea nitrogen（BUN）, serum creatinine（Cr）, alanine aminotransferase（ALT）, aspartate amin-otransferase（AST）, blood pH, sodium ion（Na＋）, bicarbonate ion（HCO3-） were collected and analyzed. Results There was no significant difference in BUN,Cr,ALT,AST and APTT of 2 different doses of ACD-A among the groups （all P〉0.05）;pH of B dose of ACD-A in group Ⅰwas significantly higher than that in A dose（F=7.384,P=0. 015）;pH of B dose of ACD-A in groupⅡwas significantly higher than that in A dose（F=4. 492,P=0. 046）,HCO3-of B dose of ACD-A in groupⅠwas significantly higher than that in A dose（F=7. 735,P=0. 013）;HCO3-of B dose of ACD-A in groupⅡwas significantly higher than that in A dose（F=4. 644,P=0. 042）;hemofilter duration of B dose of ACD-A in group Ⅲ was significantly higher than that in A dose（t=-3. 147,P=0. 016）;hemofilter duration of B dose of ACD-A in groupⅣwas significantly higher than that in A dose（t=-6. 342,P=0. 000）. Conclusions RCA-CVVH is effective and safe for critical children,and different doses of ACD-A for children with different weight can re-duce metabolic alkalosis and enhance regional anticoagulation.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2015年第18期1387-1390,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
国家自然科学基金（81272070）
关键词
连续静脉-静脉血液滤过
儿童
枸橼酸
抗凝
Continuous veno-venous hemofiltration
Child
Citrate
Anticoagulation
