Removal of sulfonamides by hemofiltration

Hemofiltration is a relatively new technique for removing toxic substances from the body. Unlike hemodialysis or hemoperfusion, the driving force behind hemofiltration is ultrafiltration. There have been several studies examining the clearance of drugs by hemofiltration but to date no study has investigated in a systematic way the effects of protein binding, perfusate flow, transmembrane pressure, and the duration of treatment on drug clearance by hemofiltration. The influence of these factors on the hemofiltration clearance of three sulfonamides with differing degrees of protein binding was investigated. It was found that hemofiltration drug clearance decreased with the duration of hemofiltration and protein binding but increased with perfusate flow and transmembrane pressure.     

Newly Developed Circulating Blood Volume-Monitoring System and Its Clinical Application for Measuring Changes in Blood Volume During Hemofiltration

Blood and ultrafiltrate electrical resistivities were continuously monitored during hemofiltration. By substituting these values into a previously developed equation that was modified by the authors, the hematocrit value was determined; and blood volume change was obtained from the change in this value. The following facts were discovered as the result of monitoring the blood volume change during treatment: When the body position was changed from the reclining to the sitting position, the blood volume decreased by 4.2 +/- 0.3%. With the body water removal rate kept constant, the body position recumbent, and the subject fasted, the blood volume gradually decreased. However, when the position was changed from reclining to sitting for food intake and once more returned to the supine position after the meal, the blood volume was greatly affected by the change in position and the food intake.     

The Hematocrit Affects the Volume of Plasma Treated With Coupled Plasma Filtration and Adsorption With Predilution

Coupled plasma filtration and adsorption (CPFA) is an extracorporeal blood purification technique proposed for the treatment of septic‐shock. By removing pro‐ and anti‐inflammatory mediators from plasma, CPFA is supposed to have a therapeutic effect on the abnormal inflammatory response seen in this condition. Recently, blood predilution with citrate solution has been adopted to prevent clotting in the CPFA circuit—one of the main problems of the technique. Taking into account the patient's hematocrit, we worked out a formula for the volume of plasma effectively treated by CPFA after predilution. Neglecting this effect, as is commonly done, introduces significant distortions in the estimation of the volume, possibly causing under‐treatment. The distortion is stronger when the hematocrit and the predilution fraction are large and weaker when both values shrink. By correctly indicating the daily dose of plasma adsorption received by patients, this formula is essential for assessing the therapeutic efficacy of CPFA and, subsequently, establishing its optimal doses.     

枸橼酸局部抗凝在脓毒症急性肾损伤患者血液滤过中抗凝作用观察

摘 要 目的：比较枸橼酸和肝素局部抗凝对脓毒症急性肾损伤患者血液滤过中抗凝作用的影响,并观察其安全性,为临床血液滤过抗凝提供依据。方法: 脓毒症急性肾损伤患者72例按入院单双数分为对照组和观察组,两组各36例。对照组和观察组在血液滤过中分别应用肝素钠和枸橼酸进行抗凝。两组患者均连续治疗７d。记录两组血滤管路及滤器寿命,评估滤器凝血分级,检测两组治疗前后SCr、BUN、pH、血钠（Na+）、碳酸氢根浓度（HCO3-）,检测血液滤过前、滤过后8 h、24 h后体外全血活化凝血时间 (ACT）,观察两组患者不良反应。结果: 观察组滤器凝血0～1级比例高于对照组,滤器凝血2～3级比例低于对照组,差异均有统计学意义(P<0.05)。观察组滤管路及滤器寿命长于对照组(P<0.05)。观察组血液滤过后8 h、24 h ACT均长于对照组(P<0.05)。两组患者滤过后BUN和Scr均低于滤过前,差异有统计学意义(P<0.05)。两组患者滤过前后血pH、HCO3-、Na+和两组不良反应比较,差异无统计学意义（P>0.05）。结论:应用血液滤过治疗脓毒症急性肾损伤患者能显著改善患者肾功能,枸橼酸局部抗凝对脓毒症急性肾损伤患者血液滤过具有良好的抗凝作用,能够延长滤管路及滤器寿命,且应用较安全。     

不同预处理对高凝倾向患者行血液滤过联合灌流治疗的效果评价

目的探讨采取不同预处理方法高凝倾向患者行血液滤过(Hemofiltration,HF)联合血液灌流(Hemoperfusion,HP)对滤器凝血发生率和灌流治疗完成情况的影响。方法选取我科2014年11月-2015年11月有高凝倾向并需紧急行床旁HF联合HP治疗的患者157例,随机分成观察组81例和对照组76例。两组患者分别采用不同的方式进行血液滤器预处理,观察并分析两组患者滤器凝血程度,灌流治疗完成情况及治疗结束时凝血功能及血常规相关指标的变化。结果 (1)两组滤器的凝血发生率比较差异有统计学意义(P0.05)。(2)两组灌流治疗完成情况比较差异有统计学意义(P0.05)。(3)两组患者治疗结束时活化部分凝血活酶(APTT-SEC)、凝血酶原时间(PT-SEC)、凝血酶时间(TT-SEC)等的比较差异均无统计学意义(P0.05);结论观察组可减少有高凝倾向的重症患者行血液滤过联合灌流治疗时滤器凝血发生率,提高灌流治疗完成率,且对血液相关因子的影响没有临床意义,具有一定临床推广价值。     

Chemotherapy with cytosine arabinoside in a child with Burkitt's lymphoma on maintenance hemodialysis and hemofiltration

Summary A case of Burkitt's lymphoma (stage IV) in an 8-year-old boy with end-stage renal failure due to hemolytic uremic syndrom is reported. The boy was treated by maintenance hemodialysis (HD) and hemofiltration (HF). During chemotherapy treatment with continuous cytosine arabinoside (Ara-C) infusion (100 mg/m²/d) for 7 days, concentrations of Ara-C and its metabolite uracil arabinoside (Ara-U) were measured in blood, dialysate, and filtrate. Ara-C levels were always below 200 ng/ml and were only qualitatively detectable in blood, dialysate, and filtrate. Ara-U levels were higher than 200 ng/ml after 18 h treatment and were measured quantitatively. Ara-U clearance during 3 h HD was 92 ml/min and the calculated mass removal 14.7 mg/3 h. In contrast, the Ara-U clearance during 3 h HF was 14 ml/min and the mass removal was 6.7 mg/3 h. Ara-C and Ara-U are eliminated by HD and HF in anuric patients. A continuous infusion of 100 mg Ara-C m²/d during HD or HF treatment did not result in a serum concentration above 200 ng/ml.     

老年患者血液透析间期并发急性左心衰竭的因素分析

目的：探讨血液透析患者发生急性左心衰竭有关临床因素。方法：43例血液透析（血透）慢性肾功能衰竭患者并发急性左心衰24例（Ⅰ组），血透当中未并发急性左心衰竭19例（Ⅱ组）；测定两组年龄、收缩压（SBP）、舒张压（DBP）血色素（Hb）、体重、超滤量等有关因素。结果：Ⅰ组及Ⅱ组之间血压、体重及超滤量有显著差异（P〈0．05）。结论：高血压，体重增加，超滤量低时较易发生急性左心衰。     

血液净化与营养支持在救治老年多器官功能障碍综合征中的作用

目的回顾性评价血液净化(bloodpurification)救治老年多器官功能障碍综合征(multipleorgandysfunctionsyndrome,MODS)伴肾功能衰竭(renalfailure,RF)中的作用,以及合适的营养支持方案。方法回顾了51例老年MODS伴RF患者的临床资料,将其分为三组:其中两组接受血液净化治疗:高蛋白组(蛋白质摄入2～2.5g·kg-1·d-1),正常蛋白组(蛋白质摄入1～1.2g·kg-1·d-1),另一组为非血液净化组(蛋白质摄入0.8g·kg-1·d-1)。比较各组的3个月生存率和生化参数。结果几乎所有的患者治疗前都存在低白蛋白血症。3个月生存率分别为高蛋白组41.7%、正常蛋白组20.7%、非血液净化组0.0%,各组相比P<0.01,有统计学意义。接受血液净化的两组对氮质血症的控制相对较好,而非血液净化组则控制不良。结论床边血液净化,特别是连续性血液净化技术(CBP)是MODS的基础治疗,同时应重视加强营养支持,尤其要提高蛋白质的摄入量,以达到正氮平衡,这样才能提高抢救成功率,延长生存时间。     

Evaluation of Plasma Exchange and Continuous Veno‐Venous Hemofiltration for the Treatment of Severe Avian Influenza A (H7N9): A Cohort Study

Avian influenza A (H7N9) is a severe disease with high mortality. Hypercytokinemia is thought to play an important role in the pathogenesis. This study was to investigate the efficiency of plasma exchange (PE) + continuous veno‐venous hemofiltration (CVVH) on the removal of inflammatory mediators and their benefits in the management of fluid overload and metabolic disturbance. In total, 40 H7N9‐infected patients were admitted to our hospital. Sixteen critically ill H7N9‐infected patients received combination of PE and CVVH. Data from these 16 patients were collected and analyzed. The effects of PE + CVVH on plasma cytokine/chemokine levels and clinical outcomes were examined. H7N9‐infected patients had increased plasma levels compared to healthy controls. After 3 h of PE + CVVH treatment, the cytokine/chemokine levels descended remarkably to lower levels and were maintained thereafter. PE + CVVH also benefited the management of fluid, cardiovascular dysfunction and metabolic disturbance. Of the 16 critically ill patients who received PE + CVVH, 10 patients survived. PE + CVVH decreased the plasma cytokine/chemokine levels significantly. PE + CVVH were also beneficial to the management of severe avian influenza A (H7N9).     

持续性高容量血液滤过治疗脓毒症合并多器官功能障碍综合征的效果观察

目的 探讨持续性高容量血液滤过用于治疗严重脓毒症合并多器官功能障碍综合征的疗效.方法 选择2011年1月至2013年10月浙江省临海市第二人民医院ICU科各种病因导致的脓毒症合并多器官功能障碍综合征(MODS)患者80例,其中42例给予持续性床旁高容量血液滤过(CHVHF)治疗,38例给予常规容量血液滤过(CVHF),观察接受两种治疗方式处理后患者治疗前后生命体征、APACHEⅡ评分、MODS评分、血流动力学参数、以及肝肾功能指标、动脉血乳酸、降钙素原(PCT)的变化.结果 患者接受CHVHF治疗后心率以及体温得到改善,APACHEⅡ评分及MODS评分显著降低[(17.2±3.1)比(9.3±4.3),(17.2±3.2)比(13.0±3.7),P＜0.05];同时CHVHF治疗后患者血流动力学明显改善,治疗后48、72 h出现好转,MAP、CI、SVI、SVRI趋于稳定,与CHVHF前相比差异均有统计学意义(均P ＜0.05);患者CHVHF治疗后肝肾功能指标趋于正常,动脉血乳酸以及PCT均逐渐下降至正常,采用CHVHF治疗后24、48、72 h与HVHF治疗前相比差异有统计学意义(P＜0.05).结论 CHVHF治疗可稳定脓毒症合并MODS患者的生命体征,改善患者血流动力学,脏器功能以及组织灌注.