一种新型置换液配方(南京).docVIP

一种新型置换液配方的实验及临床研究 常平 陶少华 胡艳群 李君 封志纯 〔摘要〕目的：检测一种新型置换液配方（自配方）在连续血液净化治疗中维持水-电解质及酸碱平衡的效果。方法：分动物实验和临床两部分，检测自配方与传统Port方两种置换液在治疗中患者血酸碱、电解质及渗透压值。结果：自配方的葡萄糖浓度、总分子浓度分别为16.2mmol/L、339 mmol/L，比Port方的65mmol/L、365 mmol/L更接近生理状况；动物实验显示自配方组3小时血糖、血钙浓度分别为7.2±0.7mmol/L 、2.3±0.2 mmol/L，明显好于Port方组的14.2±1.0mmol/L 、1.9±0.2mmol/L(P0.01)；治疗中Port方组血浆渗透压显著上升(由298±8mOsm/L至317±8mOsm/L, P0.05)，自配方组无显著变化；临床资料也显示了相似的变化趋势。结论：自配方在血糖、血钙及渗透压调控方面较优于Port方，有进一步验证及应用的价值。 〔关键词〕置换液配方；连续血液净化；电解质；渗透压 Experiment and clinic study of a new kind of substitution composition. CHANG Ping, TAO Shaohua, HU Yanqun, LI Jun, FENG Zhichun. PICU, the pediatric center of PLA, Zhujiang Hospital, the first military medical university, GuangZhou 510282 [Abstract] Objective: To test the superiority of a new kind of Substitution composition in stabilizing the plasma inner environment during continuous blood purification. Methods: we contrasted the new substitution with the Port’s one by testing the electrolytes, glucose concentration and osmolarity in animal’s or patients’ blood during CBP. Results. The glucose, calcium plasma concentration and the osmolarity of animal (7.2?0.7mmol/L, 2.3?0.2mmol/L, 306?10mOsm/L) as well as patients (11.1?3.8mmol/L, 2.0?0.3mmol/L, 325?7mOsm/L) using the new substitution were quiet different from those (animal 14.2?1.0mmol/L, 1.9?0.2mmol/L, 317?8mOsm/L, patients 16.7?3.8mmol/L, 1.6?0.2mmol/L, 333?8mOsm/L )using the old one at the same time points during CBP (P0.0.1 or P0.05). Conclusions:. The elementary results suggest that the new substitution composition may be better than the port’s one in dominating glucose, calcium plasma concentration and plasma osmolarity. [Keywords] substitution composition, continuous blood purification, electrolyte homeostasis, osmolarity 1 前言 连续血液净化（Continuous blood purification, CBP）中电解质及酸碱平衡主要由置换液维持，传统的Port置换液配方〔1〕（Port方）葡萄糖浓度及渗透压较高、钙浓度较低，我们对其进行了一些改进，通过动物实验及临床试用进行了对比观察，现报告如下。 2 方法 2.1 置换液配制方法 Port方及自配方均以市售3000ml袋装生理盐水为基础配制A液，严格无菌操作，临用前床旁配制。B液用原装市售5％碳酸氢钠注射液。其配方见表