CN116808070A - Zero-balance ultrafiltrate, preparation method thereof and application thereof in extracorporeal circulation - Google Patents

Zero-balance ultrafiltrate, preparation method thereof and application thereof in extracorporeal circulation Download PDF

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CN116808070A
CN116808070A CN202310776033.4A CN202310776033A CN116808070A CN 116808070 A CN116808070 A CN 116808070A CN 202310776033 A CN202310776033 A CN 202310776033A CN 116808070 A CN116808070 A CN 116808070A
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郭冬
邢家林
杨晓芳
关明
黑飞龙
侯晓彤
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Beijing Anzhen Hospital
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Abstract

The invention discloses zero-balance ultrafiltrate, a preparation method thereof and application thereof in extracorporeal circulation, wherein the zero-balance ultrafiltrate consists of a component A and a component B; wherein the component B is sodium bicarbonate solution; after the component A and the component B are mixed, the mixture comprises 136-145mmol/L sodium ion, 100-115mmol/L chlorine ion, 0.5-1.5mmol/L magnesium ion, 0-5mmol/L potassium ion, 0-1.5mmol/L calcium ion, 0-5.55mmol/L glucose molecule and 35mmol/L bicarbonate ion. The concentration of each element ion is reasonably set, and when the ion directly enters the blood large circulation, potential adverse effects on human tissue and organs, components of blood, other anesthesia or medicine addition in extracorporeal circulation are avoided, so that the ion-exchange type blood transfusion system is safer to use; and through verification, after ultrafiltration time is longer than 60min and ultrafiltration liquid is used for a large amount of time exceeding 5000ml, heparin application is not increased, electrolyte acid-base disorder is not caused, and adverse events are not generated.

Description

Zero-balance ultrafiltrate, preparation method thereof and application thereof in extracorporeal circulation
Technical Field
The invention relates to the field of zero-balance ultrafiltration, in particular to zero-balance ultrafiltrate, a preparation method thereof and application thereof in extracorporeal circulation.
Background
The extracorporeal circulation is the basis and condition of cardiac surgery, and is the life support technology for the extracorporeal blood of the heart, which is led to the arterial system in the body by using an artificial device, and is returned to the arterial system in the body after the artificial membrane lung is subjected to gas exchange, temperature regulation and filtration. During extracorporeal circulation, pulmonary circulation is also known as substitution of cardiopulmonary function in the human body. In the open heart surgery, the external coronary artery, the adjacent blood vessel of the heart cavity or the internal valve and muscle of the heart are often required to be operated in the state of cardiac arrest, so the purpose of extracorporeal circulation is to provide good vision for the surgery and maintain the blood supply of the whole body tissue and organs when the open heart surgery is implemented.
However, extracorporeal circulation initiates activation of an inflammatory response to varying degrees, where complement activation and cytokine release are both characteristics of such a response. The most important complement reactions leading to systemic inflammatory reactions are the degradation of complement C3 and C5, yielding C3a and C5a.3; this complement activation is associated with histamine release, platelet and leukocyte aggregation, increased vascular permeability, and pulmonary vasoconstriction. The major cytokine mediators involved in inflammatory response are tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta, interleukin-6 and interleukin-8. Complement activation and cytokines can lead to postoperative respiratory failure, renal dysfunction, neurological dysfunction, and hemorrhagic disease; and these pro-inflammatory mediators may lead to Multiple Organ Failure (MOF).
Ultrafilters are commonly used to remove excess liquid and small molecular substances associated with extracorporeal circulation, and molecules having pore sizes smaller than the pore size of the semipermeable membrane are filtered due to the transmembrane pressure gradient. Benefits associated with ultrafiltration include removal of excess fluid, improvement of patient hemodynamics, reduction of blood loss and transfusion requirements, reduction of brain damage, and increase of osmotic pressure and hematocrit. These benefits are related not only to the ability of the ultrafilter to remove excess fluid, but also to its ability to remove some of the primary mediators associated with the inflammatory response. Most inflammatory mediators have a molecular weight below the membrane pore size, allowing them to pass freely through the filter; for example: polysulfone membranes are often used as the filtration membranes of the in vitro ultrafilters, and the pore size is 60kD, so that small molecules or ions such as sodium, potassium, calcium, magnesium, chlorine, bicarbonate, phosphate, glucose, creatinine, urea and the like can be filtered out, and organic molecules in blood such as low molecular weight inflammatory factors, cytochrome C, vitamin B12, amino acids, fatty acids and the like can be removed. Ultrafiltration can prevent the continuation of the inflammatory response by removing the activated or released mediators.
Zero-equilibrium ultrafiltration (Z-BUF) was originally used by Jounois et al to describe ultrafiltration techniques for the extracorporeal circuit rewarming phase of pediatric populations, wherein the ultrafiltered liquid was replaced by an equal volume of an equilibrium electrolyte solution. The overall benefit of this form of ultrafiltration can be seen as the direct result of the removal of small molecule inflammatory factors and toxins, rather than the result of liquid volume removal, with the overall capacity unchanged; the implementation of the Z-BUF can improve the postoperative state of a patient, the Z-BUF obviously removes TNF-a, myeloperoxidase and C3a, reduces blood loss and ventilation time after Z-BUF group operation, and obviously reduces IL-6, IL-8 and myeloperoxidase in blood 24 hours after operation.
The extracorporeal circulation zero balance ultrafiltration is different from dialysis CVVH, the dialysis CVVH aims at dialysis patients, usually 250ml/min blood is led out, calcium is chelated by citric acid component, ultrafiltration operation is carried out on the calcium chelated calcium, calcium component is added, and then the calcium is returned to the body, and the ultrafiltration amount is small. The zero balance liquid in the extracorporeal circulation directly enters all blood circulation, and is filtered out by an ultrafilter after being mixed, and the ion concentration of each ion has great influence on the ion concentration in blood, especially when the ultrafiltration time is longer, the ion concentration in the blood circulation is closer to the zero balance ultrafiltrate, so that the selection of reasonable ultrafiltrate is important. According to different requirements, the filtering speed of zero-balance ultrafiltration of the extracorporeal circulation of an adult is generally about 50-150ml/min, and if the extracorporeal circulation ultrafiltration time is longer, the zero-balance ultrafiltration liquid may be required to be up to 10000ml; therefore, the ideal extracorporeal circulation zero-balance ultrafiltrate not only needs to have the characteristics of safe components, ideal osmotic pressure and acid-base balance, but also can supplement beneficial components such as filtered vitamins, essential amino acids, fatty acids and the like for the organism while filtering out high potassium, lactic acid, a part of inflammatory factors and toxins in blood.
However, no special commercialized zero-balance ultrafiltration liquid exists at present, and the zero-balance ultrafiltration is usually carried out by using dialysis replacement liquid or other balanced salt solutions in clinic, but each formula disclosed in the prior art has own defects. For example: the solution of 0.9% sodium chloride solution, sodium lactate ringer, sodium acetate ringer (Bo Maili A), legao (sodium, potassium, magnesium, calcium and glucose) dialysis substitution liquid and the like which are commonly used in clinic at present are adopted. Wherein, the 0.9 percent sodium chloride solution has high sodium and high chlorine, and is not suitable for a large amount of ultrafiltration. Sodium lactate ringer solution has low sodium content and high lactate content, and hyponatremia may cause brain cell osmotic edema, intracranial pressure increase and other nerve system injury, while lactic acid requires liver and kidney metabolism, increases liver and kidney burden, and may cause homolactic, aggravate lactic acidosis, and is not suitable for large amount of ultrafiltration. The sodium acetate ringer solution has relative ion balance, pH7.4, acetic acid is a precursor substance of bicarbonate, acetic acid metabolism can be metabolized in most tissues of a human body, even if severe shock is almost unaffected by acetic acid metabolism, the concentration of acetate in blood is obviously increased after a large amount of ultrafiltration, the sodium acetate ringer solution has certain inhibition and vasodilation effects on cardiac muscle, and can promote inflammatory reaction, and when sodium acetate ringer solution is ultrafiltered, a large amount of bicarbonate is lost, and a large amount of sodium bicarbonate is required to be additionally supplemented, so that hypernatremia is caused. A plurality of dialysis replacement solutions exist at home and abroad, and most of dialysis replacement solutions are acid solutions without bicarbonate and alkaline solutions of sodium bicarbonate, which are instantly mixed for use when in use, so that carbonate precipitation is reduced. The existing dialysis replacement fluid is designed for clinical scenes of a guardian room or a dialysis room, and special scenes and connection modes of extracorporeal circulation heart operation, such as high glucose due to stress reaction and high anticoagulation of extracorporeal circulation during extracorporeal circulation, are not considered, the replacement fluid is directly dripped into the large circulation of blood, and a plurality of ions possibly existing in priming fluid of the extracorporeal circulation are disordered, or water and food are forbidden for a long time before operation, and hyperkalemia caused by repeated infusion of hyperkalium stop fluid during operation is avoided. Especially, in critical patients (heart dysfunction, high lactic acid, pulmonary insufficiency, complex operation, advanced age, uremia, serious infection, multiple organ failure, etc.) and acute operations (aortic dissection, neonatal operation, pulmonary embolism, etc.), since a large amount of ultrafiltration is required for a long time, the existing disclosed dialysis substitution liquid at home and abroad contains much sugar or lactic acid, hyperglycemia or high lactic acid can be caused in blood when the dialysis substitution liquid is used, and hyperglycemia is likely to be treated by using insulin for lowering blood sugar, and the treatment is accompanied by a certain risk, and needs to be treated with abundant clinical experience in consideration of ionic disturbance possibly occurring in the prior liquid.
Disclosure of Invention
Therefore, the technical problem to be solved by the invention is to overcome the defect that the dialysis replacement liquid in the prior art is not suitable for a large amount of ultrafiltration for a long time, thereby providing a zero-equilibrium ultrafiltrate for solving the problems, a preparation method thereof and application thereof in extracorporeal circulation.
A zero-balance ultrafiltrate consists of a component A and a component B;
wherein the component B is sodium bicarbonate solution; after the component A and the component B are mixed, the mixture comprises 136-145mmol/L sodium ion, 100-115mmol/L chlorine ion, 0.5-1.5mmol/L magnesium ion, 0-5mmol/L potassium ion, 0-1.5mmol/L calcium ion, 0-5.55mmol/L glucose molecule and 35mmol/L bicarbonate ion.
For example: 100mmol/L, 102mmol/L, 105mmol/L, 108mmol/L, 111mmol/L, 113mmol/L, 115mmol/L chloride ion; alternatively, 0.75mmol/L, 1.00mmol/L, 1.25mmol/L, 1.5mmol/L magnesium ion; alternatively, potassium ion of 0mmol/L, 1mmol/L, 2mmol/L, 3mmol/L, 4mmol/L, 5 mmol/L; alternatively, 0mmol/L, 0.5mmol/L, 1.0mmol/L, 1.5mmol/L of calcium ion.
The component A at least comprises a basic solution consisting of NaCl solution and water; preferably, also includes, mgSO 4 Solution, KCl solution, caCl 2 One or more of a solution and a glucose solution. The molar concentration of NaCl in the component A is 100-115mmol/L.
The component A also comprises nutrient substances.
NaCl solution and MgSO in the A component 4 Solution, KCl solution, caCl 2 The solution, glucose solution and water were set separately.
The mass concentration of NaCl solution in the A component is 0.9 percent, mgSO 4 The mass concentration of the solution is 25%, the mass concentration of the KCl solution is 15%, caCl 2 The mass concentration of the solution is 5%, and the mass concentration of the glucose solution is 50%; the mass concentration of sodium bicarbonate solution in the component B is 5%.
In the A component, naCl solution and MgSO solution 4 Solution, KCl solution, caCl 2 The volume ratio of the mixture of the solution, the glucose solution and the water is (2597-2987): (3-4): (0-10): (0-10): (0-8): (1013-1403).
The preparation method of the zero-equilibrium ultrafiltrate is based on the concentration required by each ion in the zero-equilibrium ultrafiltrate, and the raw materials containing each ion are respectively configured into a component A and a component B.
When the raw materials in the A component are composed of NaCl, mgSO 4 、KCl、CaCl 2 When the raw materials are independently arranged in the form of a solution; each raw material is set to a specific concentration, and the concentration of the raw material solution or the concentration of the converted raw material solution is marked.
The conversion rule of the converted solution concentration is as follows: the total volume was used as a reference, and the molar amount of the remaining raw materials was increased per 1mL of the solution added to the raw materials except for water.
The zero-balance ultrafiltrate or the zero-balance ultrafiltrate prepared by the preparation method is applied to the preparation of exchange liquid adopted in heart related operations.
The technical scheme of the invention has the following advantages:
1. the zero balance ultrafiltrate provided by the invention has reasonable concentration setting of each element ion, wherein the concentration of sodium ions reaches 136-145mmol/L, and if the concentration is higher than the range, hypernatremia can be caused, and if the concentration is lower than the range, hyponatremia can be caused; the potassium ion range is set to be 0-5mmol/L, wherein when the potassium ion range is set to be 0-5mmol/L, the potassium ion range is improved to be within 5mmol/L mainly aiming at the condition of high potassium in blood of a patient or potential high potassium due to no urine, if the blood potassium is found to be lower than a normal plasma value, the potassium ion range is used for replenishing blood potassium at any time, and if the potassium ion range is higher than the upper limit, hyperkalemia in blood possibly occurs, serious arrhythmia is caused, and insulin is needed to be used for treatment; the range of the calcium ions is set to 0-1.5mmol/L, and if the concentration of the calcium ions is higher than the upper limit value, the patient may suffer from myocardial injury caused by hypercalcemia or calcium overload; setting the chloride ion to be 100-115mmol/L, and if the concentration of the chloride ion is higher than the upper limit value, the patient may have hyperchlorhydria; glucose is set to 0-5.55mmol/L, and if the concentration of glucose molecules is higher than the upper limit value, blood sugar tends to be high in extracorporeal circulation possibly due to stress reaction or sugar-containing pre-flushing. Therefore, when the zero balance ultrafiltration liquid with the specific content range directly enters the large circulation of blood, potential adverse effects on human tissue and organs, components of blood, other anesthesia or medicine addition in extracorporeal circulation are avoided, and the use is safer; and through verification, the formula of the invention does not cause electrolyte acid-base disorder and adverse events after ultrafiltration time is longer than 60min and ultrafiltration liquid is used for a large amount of ultrafiltration time exceeding 5000 ml.
2. The invention provides zero-balance ultrafiltrate, wherein the component A adopts NaCl solution and MgSO 4 Solution, KCl solution, caCl 2 The solution, glucose solution and water are independently arranged, the urgent requirement of extracorporeal circulation on zero balance ultrafiltration liquid in cardiac surgery is solved, fully adjustable space is provided for an extracorporeal circulation perfuser, the operation is simple, the procedure is visual, sufficient confidence is provided for the extracorporeal circulation perfuser to gradually adjust plasma ion components and acid-base states of a patient towards balance by using a large amount of ultrafiltration liquid, the solution is an innovation of a concept, the solution is a requirement of accurate medicine, meanwhile, the formula is used by all clinical common solutions, the price is low, the ion components in the plasma are all necessary components, the plasma can directly enter the blood to be in large circulation, potential adverse effects are not caused on components of human tissue organs and blood, other anesthesia or medicines added in the extracorporeal circulation, and the effect is safer.
3. The A component of the zero-balance ultrafiltrate provided by the invention also contains nutrient substances, so that inorganic phosphate, multiple vitamins, amino acids and the like can be added to supplement the nutrient substances lacking and lost by ultrafiltration, and the zero-balance ultrafiltrate better meets the requirements of organisms.
Detailed Description
Example 1
A zero-balance ultrafiltrate consists of a component A and a component B; the A component is 4000ml of liquid composed of 0.9% NaCl solution and distilled water for injection, the Na ion concentration of the mixed liquid can be calculated according to the formula, the calculation formula is that the use amount a (ml) of the 0.9% NaCl solution is multiplied by the target Na ion concentration (mmol/L) multiplied by 4000/154, and the use amount b (ml) of the distilled water for injection is multiplied by 4000-a. For example, if the concentration of sodium ions in the solution is adjusted to 154mmol/L from the molar concentration of 0.9% NaCl solution to 110mmol/L by reducing the molar concentration of 154mmol/L of 0.9% NaCl solution, the concentration of sodium ions in the solution is 110X 4000/154=2857 ml, and the concentration of sodium ions in distilled water for injection is 4000-2857=1143 ml, and it can be determined whether to increase or decrease the concentration of sodium ions according to the concentration of Na ions before extracorporeal circulation of the patient.
If the A component also contains MgSO 4 Solution, KCl solution, caCl 2 In the case of solutions and glucose solutions, KCl is dissolvedThe mass concentration of the solution is 15%, namely 1.5g of potassium chloride is prepared by water to a volume of 10ml, the molecular weight of the solution is 74.55, the concentration of potassium ions is increased by 0.503mmol/L when 1ml of the solution is added, and the concentration of chloride ions is increased by 0.503 mmol/L; if MgSO 4 The mass concentration of the solution is 25%, namely MgSO 4 ·7H 2 O2.5 g was made up to a molecular weight of 246.5 with water to a volume of 10ml, increasing the magnesium ion concentration by 0.25mmol/L per 1ml added; if CaCl 2 The mass concentration of the solution is 5 percent, namely CaCl 2 ·2H 2 O0.5 g is fixed to 10ml with water to prepare a solution, the molecular weight is 147.02, the concentration of calcium ions is increased by 0.085mmol/L and the concentration of chloride ions is increased by 0.17mmol/L when 1ml is added; if the mass concentration of the glucose solution is 50%, the molecular weight of the glucose solution is 180, and the amount of glucose molecules added per 1ml is increased by 0.694 mmol/L. At this time, the amount of 0.9% NaCl solution used in the A-component a (ml) =target Na ion concentration (mmol/L) ×4000.multidot.154 in the A-component, the amount of distilled water used for injection b (ml) =4000-a, and the total volume of the remaining components added is not higher than 30ml.
The water used in the present invention is distilled water for injection.
In the embodiment, taking a heart valve operation patient with chronic renal failure as an example, the heart valve operation patient has no urine before operation, and the potassium in blood is 5.8mmol/L before turning, and the potassium in blood is higher, so that a potassium-free formula is adopted to reduce the potassium concentration in blood; the specific potassium-free zero-equilibrium ultrafiltrate comprises the following components in percentage by weight: about 139mmol/L of sodium ion, about 105.7mmol/L of chloride ion, about 0.75mmol/L of magnesium ion, about 0.85mmol/L of calcium ion, and about 35mmol/L of bicarbonate ion.
The preparation method of the zero-balance ultrafiltrate comprises the following steps:
and firstly, calculating the dosage of the NaCl solution and water in the component A according to the calculation rule, and mixing 4000ml of 0.9% NaCl solution and distilled water for injection to form the basic solution of the component A. Wherein, the using amount of 0.9 percent NaCl solution is 2701ml, distilled water is injected 1299ml, and the sodium ions are 104mmol/L and the chloride ions are 104mmol/L after mixing;
step two, adding 3ml of 25% magnesium sulfate solution and 10ml of 5% CaCl into the basic solution in sequence 2 The solution, after adding about 104mmol/L sodium ion, about 105.7mmol/L chloride ion and magnesium in the A componentAbout 0.75mmol/L of ions, about 0.85mmol/L of calcium ions.
And step three, mixing the component A with 250ml of 5% sodium bicarbonate solution to prepare zero-balance ultrafiltrate.
The zero-balance ultrafiltrate enters the extracorporeal circulation blood storage chamber at the speed of 50-150ml/min, the ultrafiltrate leaves the blood circulation at the same speed, blood and gas analysis is needed every 30min, and the solution is adjusted or replaced at any time. In this example, a liquid feed rate of 80ml/min was used, the ultrafiltration time was 75min, and after about 6000ml of total ultrafiltrate, the blood potassium was measured to have fallen to 4.6mmol/L.
Example 2
The difference between the embodiment and the embodiment 1 is that in the embodiment, the coronary bypass operation is taken as an example of the heart shock patient, the blood pressure is low, the limbs are cool, the bypass operation is needed again, the blood sodium is 152mmol/L, the blood potassium is 3.8mmol/L, the blood magnesium is 0.4mmol/L and the lactic acid is 7.2mmol/L before the operation is completed; in order to reduce the lactic acid content, the formulation of the zero-equilibrium ultrafiltrate used in this example was: about 139mmol/L of sodium ion, about 5mmol/L of potassium ion, about 110.7mmol/L of chloride ion, about 1mmol/L of magnesium ion, about 0.85mmol/L of calcium ion and about 35mmol/L of bicarbonate ion.
The preparation method of the zero-balance ultrafiltrate comprises the following steps:
and firstly, calculating the dosage of the NaCl solution and water in the component A according to the calculation rule, and mixing 4000ml of 0.9% NaCl solution and distilled water for injection to form the basic solution of the component A. Wherein, the using amount of 0.9 percent NaCl solution is 2701ml, distilled water is injected 1299ml, and the sodium ions are 104mmol/L and the chloride ions are 104mmol/L after mixing;
step two, adding 10ml of 15% potassium chloride solution, 4ml of 25% magnesium sulfate solution and 10ml of 5% CaCl into the basic solution in sequence 2 The solution, after adding about 104mmol/L sodium ion, about 5mmol/L potassium ion, about 110.7mmol/L chloride ion, about 1mmol/L magnesium ion and about 0.85mmol/L calcium ion in the component A.
And step three, mixing the component A with 250ml of 5% sodium bicarbonate solution to prepare zero-balance ultrafiltrate.
In this example, a liquid inlet rate of 150ml/min was used, the ultrafiltration time was 67min, and after about 10000ml of total ultrafiltration liquid, it was examined that the blood sodium was 143mmol/L, the blood potassium was 4.2mmol/L, the blood magnesium was 0.8mmol/L, and the lactic acid was reduced to 3.8mmol/L.
Example 3
This example differs from example 1 in that in this example, 8 cases of acute aortic dissection patients were taken as an example, aortic CTA showed exudation in the lung, blood gas analysis showed an oxygen partial pressure of 80mmHg, suggesting severe lung injury, and zero balance ultrafiltration was selected for filtering out inflammatory factors and reducing lung injury. The formulation of the zero-equilibrium ultrafiltrate employed in this example was: about 139mmol/L of sodium ion, about 4mmol/L of potassium ion, about 109.7mmol/L of chloride ion, about 0.75mmol/L of magnesium ion, about 0.85mmol/L of calcium ion and about 35mmol/L of bicarbonate ion.
The preparation method of the zero-balance ultrafiltrate comprises the following steps:
and firstly, calculating the dosage of the NaCl solution and water in the component A according to the calculation rule, and mixing 4000ml of 0.9% NaCl solution and distilled water for injection to form the basic solution of the component A. Wherein, the using amount of 0.9 percent NaCl solution is 2701ml, distilled water is injected 1299ml, and the sodium ions are 104mmol/L and the chloride ions are 104mmol/L after mixing;
step two, adding 8ml of 15% potassium chloride solution, 3ml of 25% magnesium sulfate solution and 10ml of 5% CaCl into the basic solution in sequence 2 The solution, after adding about 104mmol/L of sodium ion, about 4mmol/L of potassium ion, about 109.7mmol/L of chloride ion, about 0.75mmol/L of magnesium ion and 0.85mmol/L of calcium ion in the component A.
And step three, mixing the component A with 250ml of 5% sodium bicarbonate solution to prepare zero-balance ultrafiltrate.
In this example, a liquid feed rate of 150ml/min was used, the ultrafiltration time averaged 110min, and the total ultrafiltration liquid was about 8000-12000ml.
Example 4
This example differs from example 1 in that the patient in this example is hypercalcemia, 3.1mmol/L of calcium ions and 4.9mmol/L of blood glucose before extracorporeal circulation. The formulation of the zero-equilibrium ultrafiltrate employed in this example was: about 139mmol/L of sodium ion, about 4mmol/L of potassium ion, about 106.7mmol/L of chloride ion, about 0.75mmol/L of magnesium ion, about 0mmol/L of calcium ion, about 5.55mmol/L of glucose, and about 35mmol/L of bicarbonate.
The preparation method of the zero-balance ultrafiltrate comprises the following steps:
and firstly, calculating the dosage of the NaCl solution and water in the component A according to the calculation rule, and mixing 4000ml of 0.9% NaCl solution and distilled water for injection to form the basic solution of the component A. Wherein, the using amount of 0.9 percent NaCl solution is 2701ml, distilled water is injected 1299ml, and the sodium ions are 104mmol/L and the chloride ions are 104mmol/L after mixing;
and step two, adding 8ml of 15% potassium chloride solution, 3ml of 25% magnesium sulfate solution and 8ml of 50% glucose solution into the basic solution in sequence, wherein the sodium ions are about 104mmol/L, the potassium ions are about 4mmol/L, the chloride ions are about 108mmol/L, the magnesium ions are about 0.75mmol/L and the glucose is about 5.55mmol/L in the component A after the addition.
And step three, mixing the component A with 250ml of 5% sodium bicarbonate solution to prepare zero-balance ultrafiltrate.
In this example, a liquid feed rate of 150ml/min was used, the ultrafiltration time was 78min, the total ultrafiltration liquid volume was about 11000ml, the calcium blood after ultrafiltration was 2.6mmol/L, and the blood glucose was 6.6mmol/L.
After the patient in each embodiment uses the zero-equilibrium ultrafiltrate, electrolyte acid-base disorder and adverse events are not caused, and the zero-equilibrium ultrafiltrate is proved to be safe to use and has no side effect, so that the zero-equilibrium ultrafiltrate is suitable for long-time and large-scale ultrafiltration of extracorporeal circulation in cardiac surgery.
It is apparent that the above examples are given by way of illustration only and are not limiting of the embodiments. Other variations or modifications of the above teachings will be apparent to those of ordinary skill in the art. It is not necessary here nor is it exhaustive of all embodiments. While still being apparent from variations or modifications that may be made by those skilled in the art are within the scope of the invention.

Claims (10)

1. The zero-balance ultrafiltrate is characterized by comprising a component A and a component B;
wherein the component B is sodium bicarbonate solution; after the component A and the component B are mixed, the mixture comprises 136-145mmol/L sodium ion, 100-115mmol/L chlorine ion, 0.5-1.5mmol/L magnesium ion, 0-5mmol/L potassium ion, 0-1.5mmol/L calcium ion, 0-5.55mmol/L glucose molecule and 35mmol/L bicarbonate ion.
2. A zero-equilibrium ultrafiltrate according to claim 1, wherein the a-component comprises at least a base solution of NaCl solution and water; preferably, it also includes MgSO 4 Solution, KCl solution, caCl 2 One or more of a solution and a glucose solution.
3. A zero-balance ultrafiltrate according to claim 2, wherein said a component further comprises nutrients.
4. A zero-equilibrium ultrafiltrate according to claim 2 or 3, wherein the NaCl solution, mgSO of component a 4 Solution, KCl solution, caCl 2 The solution, glucose solution and water were set separately.
5. The zero-equilibrium ultrafiltrate of claim 4, wherein the concentration of NaCl solution in the A-phase is 0.9% by mass, mgSO 4 The mass concentration of the solution is 25%, the mass concentration of the KCl solution is 15%, caCl 2 The mass concentration of the solution is 5%, and the mass concentration of the glucose solution is 50%; the mass concentration of sodium bicarbonate solution in the component B is 5%.
6. The zero-equilibrium ultrafiltrate of claim 5, wherein in said a-component, naCl solution, mgSO 4 Solution, KCl solution, caCl 2 The volume ratio of the mixture of the solution, the glucose solution and the water is (2597-2987): (3-4): (0-10): (0-10): (0-8): (1013-1403).
7. The method according to any one of claims 1 to 6, wherein the raw materials containing each ion are formulated into a component a and a component B, respectively, based on the concentration required for each ion in a zero-equilibrium ultrafiltrate.
8. The process according to claim 7, wherein when the starting materials in component A are composed of NaCl, mgSO 4 、KCl、CaCl 2 When the raw materials are independently arranged in the form of a solution; each raw material is set to a specific concentration, and the concentration of the raw material solution or the concentration of the converted raw material solution is marked.
9. The method according to claim 8, wherein the conversion rule of the converted solution concentration is: the total volume was used as a reference, and the molar amount of the remaining raw materials was increased per 1mL of the solution added to the raw materials except for water.
10. Use of a zero-balance ultrafiltrate according to any one of claims 1-6 or a zero-balance ultrafiltrate prepared by a method according to any one of claims 7-9 for the preparation of an exchange fluid for use in heart-related surgery.
CN202310776033.4A 2023-06-28 2023-06-28 Zero-balance ultrafiltrate, preparation method thereof and application thereof in extracorporeal circulation Pending CN116808070A (en)

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