CN110860005A - Improved infusion system and drug applied to CBP citric acid anticoagulation - Google Patents

Improved infusion system and drug applied to CBP citric acid anticoagulation Download PDF

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CN110860005A
CN110860005A CN201911221060.5A CN201911221060A CN110860005A CN 110860005 A CN110860005 A CN 110860005A CN 201911221060 A CN201911221060 A CN 201911221060A CN 110860005 A CN110860005 A CN 110860005A
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anticoagulation
cbp
citric acid
infusion system
venous
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卢亮
高欣
周娜
付军桦
李笑稚
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Affiliated Hospital of University of Qingdao
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3621—Extra-corporeal blood circuits
    • A61M1/3666—Cardiac or cardiopulmonary bypass, e.g. heart-lung machines
    • A61M1/3667—Cardiac or cardiopulmonary bypass, e.g. heart-lung machines with assisted venous return
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/194—Carboxylic acids, e.g. valproic acid having two or more carboxyl groups, e.g. succinic, maleic or phthalic acid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3672—Means preventing coagulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
    • A61P7/02—Antithrombotic agents; Anticoagulants; Platelet aggregation inhibitors

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Abstract

The invention belongs to the technical field of citric acid anticoagulation, and discloses an improved infusion system and a drug applied to CBP citric acid anticoagulation, wherein a blood pump is connected with a blood filter, the blood filter is also connected with a venous pot, the upper end of the venous pot is connected with a group pump for pumping 4% sodium citrate for anticoagulation, the minimum dosage of a 4% sodium citrate solution pump for anticoagulation pumped by the group pump is 10-20ml/h, the blood filter is communicated with an ultrafiltrate output pipe, and the upper end of the venous pot is also communicated with a replacement fluid input pipe. The improved citric acid infusion system can effectively reduce the risk of coagulation of the venous kettle, does not aggravate self-bleeding of a patient, ensures the effectiveness and continuity of CBP treatment and reduces the treatment cost of the patient.

Description

Improved infusion system and drug applied to CBP citric acid anticoagulation
Technical Field
The invention belongs to the technical field of citric acid anticoagulation, and particularly relates to an improved infusion system and a drug applied to CBP treatment of citric acid anticoagulation.
Background
Currently, the closest prior art: in recent years, the application of citric acid anticoagulation technology in CBP treatment is widely accepted, but the citric acid anticoagulation applied at present is mostly infused from a single-needle double-lumen arterial end, venous kettle coagulation becomes a main factor forced by CBP treatment, and the venous kettle has important safety significance in an extracorporeal circulation device. It is located at a point prior to the return of blood to the patient where clotting is likely to occur. At present, heparin anticoagulation is mostly adopted for CBP treatment, the in vitro anticoagulation effect is poor, after the citric acid anticoagulation is applied to CBP, the in vitro anticoagulation effect is greatly improved, the abnormal blood coagulation function of a patient cannot be caused, and the citric acid anticoagulation technology is widely applied. The prior art can not solve the problem of venous kettle coagulation under the condition of keeping the total amount of citric acid unchanged, and the several reasons of venous kettle coagulation are as follows: 1. the filter before the venous kettle can remove and adsorb part of citric acid; 2. most of the replacement fluids used at present contain calcium iGa2+Filling from venous pot further aggravates venous pot coagulation (citric acid passes through and iGa)2+The coagulation pathway is cut by complexation to achieve the effect of anticoagulation in vitro). In the process of using the traditional citric acid anticoagulation mode (citric acid is completely pumped from the CBP single-needle double-lumen arterial end), the filter is well protected, but the venous pot becomes the most easy coagulation point of the anticoagulation mode. 3. The blood flow in the cavity of the venous pot becomes slow or stagnates 4. an 'air-blood' contact surface 5 is formed in the venous pot, and the blood forms a turbulent flow 6 at the inlet of the venous pot and a filter screen structure arranged in the venous pot is easy to become an attachment point of thrombus.
In summary, the problems of the prior art are as follows: in the application process of the traditional citric acid anticoagulation equipment, a filter is well protected, but a venous pot becomes the most easy coagulation point of the anticoagulation mode, and if the venous pot is completely blocked by thrombus, blood cannot return according to a normal procedure, so that blood loss can be caused; the machine is frequently operated, the required related consumables are increased, and the treatment cost is correspondingly increased; and the times of flushing the pipeline by the physiological saline are increased, and the workload is increased.
The difficulty of solving the technical problems is as follows: (1) research shows that citrate can be removed by more than 60% when passing through a filter, and blood coagulation at the venous pot part is more obvious.
(2) The replacement liquid of the current clinical application finished product is calcium-containing replacement liquid, the replacement liquid is mixed with blood from the venous pot, and the iCa at the venous pot2+Further increasing.
(3) Blood flow at the venous pot is relatively slow, exacerbating the risk of clotting.
(4) The "blood-gas" barrier at the venous pot exacerbates the risk of clotting.
(5) The bottom of the venous pot is provided with a filter screen structure for preventing thrombus from entering the body of a patient, and the filter screen structure can aggravate the blood coagulation risk.
The significance of solving the technical problems is as follows: (1) the solution of the coagulation of the venous kettle can greatly prolong the service life of the extracorporeal circulation pipeline, prolong the effective treatment time of CBP and improve the application efficiency.
(2) The venous pot is the last line of defense for blood to be returned back to the body through an extracorporeal circulation pipeline, and the improvement of anticoagulation can improve the risk of sudden thromboembolism of a patient.
(3) Because of the built-in filter screen structure of the venous pot, once the big thrombus at the bottom of the venous pot is blocked, CBP (cubic boron nitride) can not be discharged according to normal procedures, and the blood in the extracorporeal circulation passage can not be smoothly returned to the body of a patient, so that artificial blood loss can be caused.
(4) The venous pot still lacks effectual thrombus monitoring technology, relies on staff's experience to judge at present, but the improvement of anticoagulation technique greatly reduced burst pipeline blocks up's risk, simultaneously greatly reduced staff's work load.
(5) CBP periphery circulation route life extension, treatment effeciency improves, and the patient is used for changing the consumptive material expense that CBP managed during being in hospital and reduces.
Disclosure of Invention
Aiming at the problems in the prior art, the invention provides an improved infusion system applied to CBP treatment citric acid anticoagulation.
The improved infusion system applied to CBP treatment citric acid anticoagulation is realized in the way that the improved infusion system comprises a blood pump and a blood filter connected with the blood pump, wherein the blood filter is also connected with a venous pot, and the upper end of the venous pot is connected with a group pump for pumping 4% sodium citrate for anticoagulation.
Furthermore, the minimum dosage of the 4 percent sodium citrate solution pump for anticoagulation pumped by the group pump is 10-20ml/h relative to 2000ml/h of finished product hemofiltration and replacement base solution, and the minimum dosage contains iCa2+1.5mmol/L)。
Further, the blood filter is communicated with an ultrafiltrate output tube.
Furthermore, the upper end of the venous pot is also communicated with a replacement fluid input pipe.
The invention also aims to provide an anticoagulant drug applied to CBP treatment, which is applied to the infusion of the improved infusion system applied to CBP treatment for anticoagulation of citric acid, wherein the anticoagulant drug applied to CBP treatment is 4% sodium citrate solution.
In summary, the advantages and positive effects of the invention are: the improved citric acid infusion system can effectively reduce the risk of venous kettle coagulation, and simultaneously can not aggravate bleeding, thereby ensuring the effectiveness and continuity of CBP treatment and reducing the treatment cost.
The anticoagulant drug applied to CBP treatment is 4% sodium citrate solution. The service life of the extracorporeal circulation pipeline is greatly prolonged, the effective treatment time of CBP is prolonged, and the application efficiency is improved.
Improved anticoagulation may improve the risk of sudden thromboembolism in patients. The improvement of anticoagulation can greatly reduced the risk that unexpected pipeline blockked up, simultaneously greatly reduced staff's work load. CBP periphery circulation route life extension, treatment effeciency improves, and the patient is used for changing the consumptive material expense that CBP managed during being in hospital and reduces.
Drawings
Fig. 1 is a schematic diagram of a model of an experimental group provided in an embodiment of the present invention.
Fig. 2 is a schematic diagram of the principle of the control group mode provided by the embodiment of the present invention.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention more apparent, the present invention is further described in detail with reference to the following embodiments. It should be understood that the specific embodiments described herein are merely illustrative of the invention and are not intended to limit the invention.
Aiming at the problems in the prior art, as shown in figure 1, the invention provides an improved infusion system applied to CBP treatment for citric acid anticoagulation, which comprises a blood pump and a blood filter connected with the blood pump, wherein the blood filter is also connected with a venous pot, and the upper end of the venous pot is connected with a group pump for pumping 4% sodium citrate for anticoagulation.
In the embodiment of the invention, the minimum dosage of the 4% sodium citrate solution pump for anticoagulation pumped by the group pump is 10-20ml/h relative to 2000ml/h of finished product hemofiltration and replacement base solution, and the minimum dosage contains iCa2+1.5 mmol/L).
In the embodiment of the invention, the blood filter is communicated with an ultrafiltrate outlet pipe.
In the embodiment of the invention, the upper end of the venous pot is also communicated with a replacement fluid input pipe.
The invention is further described below with reference to the accompanying drawings.
Fig. 1 is a schematic diagram of a model of an experimental group provided in an embodiment of the present invention. 4% anticoagulant sodium citrate solution 185-205ml/h is pumped into the arterial end of the patient femoral vein single-needle double-lumen catheter, the blood flow speed of a hemofilter is constant at 150ml/min, the hemofiltration replacement base solution 2000ml/h is selected and then is pumped into the venous pot by a dilution method, 4% anticoagulant sodium citrate solution group pump 15ml/h is pumped into the venous pot, and 10% calcium gluconate injection group pump 5ml/h is pumped into the patient from the venous end of the patient femoral vein single-needle double-lumen catheter.
Fig. 2 is a schematic diagram of the principle of the control group mode provided by the embodiment of the present invention. The 4% anticoagulant sodium citrate solution 200-.
In the embodiment of the invention, the anticoagulant drug applied to CBP treatment, which is applied to infusion of the improved infusion system for CBP treatment citrate anticoagulation, is provided, and the anticoagulant drug applied to CBP treatment is 4% sodium citrate solution.
The technical effects of the present invention will be described in detail with reference to experiments.
The results of comparison of the extracorporeal circulation passage filters and the coagulation conditions of venous kettles of the two groups of patients show that the coagulation grade of the venous kettles of the patients in the observation group is lower than that of the control group, the difference has statistical significance (P is less than 0.05), and the result shows that the anticoagulation condition of the CBP venous kettles in the citric acid infusion mode of the observation group is better than that of the control group. The difference in the clotting status of the extracorporeal circulation filters of two groups of patients was not statistically significant (P >0.05), see Table 1.
TABLE 1 comparison of the coagulation status of the extracorporeal dialyzer and venous kettle of two groups of patients n (%)
Figure BDA0002300860570000041
Figure BDA0002300860570000051
The results of comparison of filtered calcium, peripheral calcium and bicarbonate radicals of two groups of patients show that the two local citric acid infusion modes can maintain lower blood calcium concentration, and the patients do not have hypocalcemia. The differences were not statistically significant (P >0.05), see Table 2.
TABLE 2 comparison of calcium, peripheral calcium and bicarbonate radical after filtration (x. + -. s) for two groups of patients
Figure BDA0002300860570000052
The results of comparing the service lives of the extracorporeal circulation paths of the two groups of patients show that the service lives of the extracorporeal circulation paths of the observation group are (57.14 +/-22.02) hours, the service lives of the extracorporeal circulation paths of the control group are (23.36 +/-8.56) hours, and the difference of the service lives of the extracorporeal circulation paths of the two groups has statistical significance (t is 16.00, p is less than 0.01), which is shown in table 3.
TABLE 3 comparison of the service lives of extracorporeal circulation circuits of two groups of patients (x. + -. s)
Figure BDA0002300860570000053
To be provided with
Research shows that more than 60 percent of citrate can be removed when passing through a dialyzer, and the replacement liquid used in clinic at present is calcium-containing replacement liquid containing iCa2+1.5mmol/L, in the post-dilution method, the replacement fluid can be mixed with blood at the venous pot, the venous pot of the invention can supplement part of citric acid removed by a filter and iCa in the complexing replacement fluid after a group of citric acid is added2+To reduce the possibility of venous kettle coagulation, a sodium citrate solution for anticoagulation (containing iCa at 2000ml/h relative to hemofiltration replacement base fluid) of 10-20ml/h is calculated2+1.5mmol/L) is pumped in the minimum dose that achieves the effect, and the reduction of this dose from the arterial end does not affect the anticoagulation effect of the filter (excessive citric acid pumping will burden the liver of the patient, causing citric acidosis in the patient). Thereby well solving the problem of the coagulation of the venous pot. The K-M graph of the extracorporeal circulation circuit service life of the patient shows that the median service time in the observation group is 77 hours and the median service time in the control group is 48 hours. And the risk of coagulation in the observation group was 0.125 times that in the control group. The consumable used in the CBP treatment single time is close to 2000 yuan, the service life of the extracorporeal circulation passage of the observation group is (57.14 +/-22.02) hours, and the service life of the extracorporeal circulation passage of the control group is (23.36 +/-8.56) hours.
The above description is only for the purpose of illustrating the preferred embodiments of the present invention and is not to be construed as limiting the invention, and any modifications, equivalents and improvements made within the spirit and principle of the present invention are intended to be included within the scope of the present invention.

Claims (6)

1. The utility model provides an be applied to CBP treatment citrate anticoagulation's improvement infusion system, includes blood pump and the blood filter of being connected with the blood pump, its characterized in that, the blood filter still is connected with the venous pot, and venous pot upper end is connected with the group pump that is used for pumping into anticoagulation with 4% citric acid sodium.
2. The improved infusion system for CBP therapy for anticoagulation of citric acid according to claim 1, wherein said venous pot further comprises a replacement fluid inlet tube at its upper end.
3. The improved infusion system for CBP therapy citric acid anticoagulation according to claim 1, wherein said group pump pumps total ml ═ venous pot citric acid amount ml + arterial end citric acid amount ml.
4. The improved infusion system for CBP therapy for anticoagulation of citric acid according to claim 1, wherein said 4% anticoagulation is pumped with sodium citrate solution at minimum dose of 10-20 ml/h.
5. The improved infusion system for CBP therapy for anticoagulation of citric acid according to claim 1, wherein said hemofilter is connected to ultrafiltrate outlet line.
6. An anticoagulant drug for CBP treatment, which is applied to the infusion of the improved infusion system for CBP treatment citrate anticoagulation according to any one of claims 1-5, wherein the anticoagulant drug for CBP treatment is 4% sodium citrate solution.
CN201911221060.5A 2019-12-03 2019-12-03 Improved infusion system and drug applied to CBP citric acid anticoagulation Withdrawn CN110860005A (en)

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN113018546A (en) * 2021-03-17 2021-06-25 上海溯湃医疗科技有限公司 Regional citric acid anticoagulation infusion system, control method, system and medium

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN113018546A (en) * 2021-03-17 2021-06-25 上海溯湃医疗科技有限公司 Regional citric acid anticoagulation infusion system, control method, system and medium
CN113018546B (en) * 2021-03-17 2023-03-21 上海溯湃医疗科技有限公司 Regional citric acid anticoagulation infusion system, control method, system and medium

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Application publication date: 20200306