不同复用方式对连续性静脉-静脉血液透析滤过溶质清除率的影响

目的　探讨不同透析器复用方式在不同剂量的连续性静脉 静脉血液透析滤过 (CVVHDF)时对各种大小溶质清除率的影响。方法　采用体外实验 ,聚砜膜F6 0透析器共分 3组 ,A组为首次使用的透析器 ,B组为用次氯酸钠加甲醛复用的透析器 ,C组为单用甲醛复用的透析器 ,分别行不同剂量的前稀释和后稀释CVVHDF ,同时测定尿素、维生素B12 、菊粉的清除率。结果　不同剂量的CVVHDF方式对小分子物质的清除率在 3组间无显著差异 ,对中、大分子物质的清除率 ,C组较A组显著下降 (P <0 .0 5 ) ,置换液量越大 ,下降越明显。B组较A组清除率有上升趋势 ,置换液量越大 ,趋势越明显。结论　CVVHDF时透析器复用要加入漂白剂成份才能确保中、大分子清除率不变

Effects of different reuse methods of hemodialyzer on solute clearance rate in various continuous venovenous hemodiafiltration

Objective To evaluate the effects of different reuse methods of hemodialyzer on solute clearance rate in various continuous venovenous hemodiafiltration (CVVHDF). Methods In vitro model, eighteen polysulfone hemodialyzers(F60) were divided into three groups. Group A was new hemodialyzers, group B was bleach/formaldehyde reprocessing hemodialyzers, and group C was only formaldehyde reprocessing ones. Methods of continuous renal replacement therapy (CRRT) were different flow rates of pre and post CVVHDF. Solute clearances of urea, vitamin B12 and inulin were determined. Results Urea clearances among the three groups did not differ significantly by any methods of CVVHDF. In pre and post CVVHDF, the clearances of Vitamin B12 and inulin were notablely lower in Group C than those in Group A ( P <0.05). The difference of the two groups became greater when the fluid volume of ultrafiltration was increased. Conclusion Bleach reprocessing is necessary for ploysulfone dialyzers to ensure the maintenance of larger solute clearances in CVVHDF.