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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%NaHCO3250ml、10%KCl12ml、10%葡萄糖酸钙40ml、25%MgSO43ml。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。
Objective To explore the reasonable formulation of replacement fluid during high-volume hemofiltration. Methods 37 cases of MODS were treated with high-volume hemofiltration in Zhongshan Hospital Affiliated to Fudan University from January 2002 to December 2003. The hemodynamics, liver and kidney function, blood electrolyte and acid-base balance in patients before and after treatment were prospectively observed Variety. Replacement solution formula 2500ml saline, water for injection 1000ml, 50% glucose water 10ml, 5% NaHCO3250ml, 10% KCl12ml, 10% calcium gluconate 40ml, 25% MgSO43ml. Dilution of the previous input, the use of low molecular weight heparin anticoagulant. Results A total of 171 patients were treated in 37 patients. The hemodynamic parameters, such as heart rate, mean arterial pressure and central venous pressure, were stable during the course of hemofiltration. Serum potassium, sodium, chloride, calcium, phosphorus, magnesium, ALT, AST , Albumin, globulin, blood glucose and other biochemical indicators of stability before and after treatment. Blood pH, PCO2, HCO3- and other indicators of acid-base stability before and after treatment, PO2, BE after treatment than before treatment significantly improved. After treatment TB, CB, Cr and other indicators were significantly improved than before treatment. Conclusion The preparation of home-made replacement fluid simple, accurate ion concentration can be safely applied to high-volume hemofiltration therapy.