CN117339041A - 一种枸橼酸等量换算方法及其应用 - Google Patents

一种枸橼酸等量换算方法及其应用 Download PDF

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CN117339041A
CN117339041A CN202311571569.9A CN202311571569A CN117339041A CN 117339041 A CN117339041 A CN 117339041A CN 202311571569 A CN202311571569 A CN 202311571569A CN 117339041 A CN117339041 A CN 117339041A
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白科
李东
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Childrens Hospital of Chongqing Medical University
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Abstract

本发明涉及一种枸橼酸等量换算方法及其应用,属于临床连续性血液净化治疗技术领域。本发明通过枸橼酸抗凝连续性肾脏替代治疗中4%枸橼酸钠速度来计算序贯血浆置换中血浆速度或4%枸橼酸钠速度,在个体化桥接RCA‑CRRT行RCA‑PE中具有良好的应用效果,(1)若RCA‑PE前RCA‑CRRT抗凝方案处于稳定状态且无枸橼酸蓄积,若经此方式序贯行RCA‑PE,理论上RCA‑PE将不会出现枸橼酸蓄积,因RCA‑PE和RCA‑CRRT枸橼酸总量大致相当;(2)可以保障RCA‑PE全程的有效抗凝;(3)可以减少RCA‑PE体内/外离子钙浓度的频繁监测;(4)可以有效的避免枸橼酸蓄积相关严重低钙血症等严重并发症。

Description

一种枸橼酸等量换算方法及其应用
技术领域
本发明属于临床持续性血液净化治疗技术领域,涉及一种枸橼酸等量换算方法及其应用。
背景技术
局部枸橼酸抗凝(RCA)为目前连续性肾脏替代治疗(CRRT)的首选抗凝方式,且局部枸橼酸抗凝(RCA)在血浆置换(PE)中的应用也有相应的报道,RCA-CRRT和RCA-PE均有初始参数推荐。
因为不同患儿对枸橼酸的耐受性(对枸橼酸的代谢能力)差异较大,因此需要在初始参数的基础上不断的监测体内/外离子钙浓度和体内总钙,并调整参数以达到合适的局部枸橼酸抗凝(RCA)方案。而RCA-PE的治疗时间短(仅2小时左右),尽管通过加强监测与调整,仍有可能到RCA-PE结束时仍没达到最佳的局部枸橼酸抗凝(RCA)方案。部分患儿因病情,需要RCA-CRRT序贯进行RCA-PE治疗,而同一患儿在序贯进行RCA-CRRT和RCA-PE期间的枸橼酸耐受量几乎一致。
RCA-CRRT的时间较长,相对容易通过监测与调整达到合适的RCA抗凝方案,理论上可通过RCA-CRRT推算出患儿的枸橼酸耐受量,再由此制定个体化的RCA-PE方案。
发明内容
有鉴于此,本发明的目的在于提供枸橼酸等量换算方法在个体化桥接局部枸橼酸抗凝CRRT和PE的临床应用。
为达到上述目的,本发明提供如下技术方案:
1.一种枸橼酸等量换算方法,所述枸橼酸等量换算方法具体为如下方案一或者方案二中的任意一种:
方案一,通过设置RCA-CRRT阶段中血泵速度和RCA-PE阶段中血泵速度来计算RCA-PE阶段中血浆速度,具体计算方法如下:
(1)计算RCA-CRRT阶段中进入身体的4%枸橼酸钠含量:
QCi*=QCi×(1-10%),其中QB×1.5≤QCi≤QB×1.8,所述QB和QCi分别以ml/min和ml/h为单位进行数值计算,
(2)计算RCA-PE阶段中4%枸橼酸钠进入身体的含量:
QCi#=QCi@×(1-10%),其中QBP×1.0≤QCi@≤QBP×1.2,
(3)计算血浆可提供的4%枸橼酸钠上限含量:
QCiP=QCi*-QCi#
(4)计算血浆速度:
QP=QCiP×9;
方案二,通过设置RCA-CRRT阶段血泵速度和RCA-PE阶段血浆速度来计算RCA-PE阶段血泵速度,具体计算方法如下:
(1)计算RCA-CRRT阶段中进入身体的4%枸橼酸钠含量:
QCi*=QCi×(1-10%),其中QB×1.5≤QCi≤QB×1.8,,所述QB和QCi分别以ml/min和ml/h为单位进行数值计算,
(2)计算RCA-PE阶段血浆中4%枸橼酸钠速度
QCiP=QP÷9,
(3)计算RCA-PE阶段经血浆分离器清除后可使用的4%枸橼酸钠上限量:
QCi&=QCi*-QCiP
(4)计算RCA-PE阶段4%枸橼酸钠速度:
QCi@=QCi&÷(1-10%),
(5)计算RCA-PE阶段中血泵速度:
QCi@÷1.2≤QBP≤QCi@÷1.0;
其中QCi为RCA-CRRT阶段4%枸橼酸钠速度、单位为ml/h,QCi*为RCA-CRRT阶段假定的患儿枸橼酸耐受量、单位为ml/h,QB为RCA-CRRT阶段血泵速度、单位为ml/min,QCiP为RCA-PE阶段血浆可提供的4%枸橼酸钠量、单位为ml/h,QP为RCA-PE阶段血浆速度、单位为ml/h,QCi#为RCA-QCi@经血浆分离器清除后估算的4%枸橼酸钠速度、单位为ml/h,QCi&为RCA-PE阶段经血浆分离器清除后可使用的4%枸橼酸钠上限量、单位为ml/h,QCi@为RCA-PE阶段4%枸橼酸钠速度、单位为ml/h,QBP为RCA-PE阶段血泵速度,单位为ml/min。
2.上述枸橼酸等量换算方法在个体化桥接局部枸橼酸抗凝CRRT和PE的临床应用。
本发明的有益效果在于:本发明公开了一种枸橼酸等量换算方法及其应用,主要通过CRRT中4%枸橼酸钠速度来计算PE中血浆速度或4%枸橼酸钠速度,在个体化桥接RCA-CRRT和RCA-PE中具有良好的应用效果,主要具有以下优点:(1)若RCA-PE前RCA-CRRT抗凝方案处于稳定状态且无枸橼酸蓄积,若经此方式序贯行RCA-PE,理论上RCA-PE将不会出现枸橼酸蓄积,因RCA-PE和RCA-CRRT枸橼酸总量大致相当;(2)可以保障RCA-PE全程的有效抗凝;(3)可以减少RCA-PE体内/外离子钙浓度的频繁监测;(4)可以有效的避免枸橼酸蓄积相关严重低钙血症等严重并发症。
本发明的其他优点、目标和特征在某种程度上将在随后的说明书中进行阐述,并且在某种程度上,基于对下文的考察研究对本领域技术人员而言将是显而易见的,或者可以从本发明的实践中得到教导。本发明的目标和其他优点可以通过下面的说明书来实现和获得。
附图说明
为了使本发明的目的、技术方案和优点更加清楚,下面将结合附图对本发明作优选的详细描述,其中:
图1为本发明用枸橼酸等量换算方法中RCA-CRRT阶段和RCA-PE阶段的流程。
具体实施方式
以下通过特定的具体实例说明本发明的实施方式,本领域技术人员可由本说明书所揭露的内容轻易地了解本发明的其他优点与功效。本发明还可以通过另外不同的具体实施方式加以实施或应用,本说明书中的各项细节也可以基于不同观点与应用,在没有背离本发明的精神下进行各种修饰或改变。需要说明的是,以下实施例中所提供的图示仅以示意方式说明本发明的基本构想,在不冲突的情况下,以下实施例及实施例中的特征可以相互组合。
本发明用枸橼酸等量换算方法中RCA-CRRT阶段和RCA-PE阶段的流程如图1所示。
下列实施例中,QCi为RCA-CRRT阶段4%枸橼酸钠速度、单位为ml/h,QCi*为RCA-CRRT阶段假定的患儿枸橼酸耐受量、单位为ml/h,QB为RCA-CRRT阶段血泵速度、单位为ml/min,QCiP为RCA-PE阶段血浆可提供的4%枸橼酸钠量、单位为ml/h,QP为RCA-PE阶段血浆速度、单位为ml/h,QCi#为RCA-QCi@经血浆分离器清除后估算的4%枸橼酸钠速度、单位为ml/h,QCi&为RCA-PE阶段经血浆分离器清除后可使用的4%枸橼酸钠上限量、单位为ml/h,QCi@为RCA-PE阶段4%枸橼酸钠速度、单位为ml/h,QBP为RCA-PE阶段血泵速度,单位为ml/min。
实施例1
对体重10Kg的患者,设置RCA-CRRT阶段血泵速度(QB=50ml/min)和RCA-PE阶段血泵速度(QBP=30ml/min),采用枸橼酸等量换算方法来计算RCA-PE阶段中血浆速度,具体如下所示:
(1)计算RCA-CRRT阶段中进入身体的4%枸橼酸钠含量:
QCi*=QCi×(1-10%),其中QB×1.5≤QCi≤QB×1.8(其中QB和QCi分别以ml/min和ml/h为单位进行数值计算),RCA-CRRT阶段中4%枸橼酸钠进入身体经过滤器清楚,清除率为10%,
计算得到:RCA-CRRT阶段4%枸橼酸钠速度(QCi)的取值范围为75ml/h~90ml/h,RCA-CRRT阶段假定的患儿枸橼酸耐受量(QCi*)的取值范围为67.5ml/h~81ml/h。
(2)计算RCA-PE阶段中4%枸橼酸钠进入身体的含量:
QCi#=QCi@×(1-10%),其中QBP×1.0≤QCi@≤QBP×1.2,血浆中4%枸橼酸钠含量为进入身体的4%枸橼酸钠含量的九分之一,
计算得到:RCA-PE阶段4%枸橼酸钠速度(QCi@)的取值范围为30ml/h~36ml/h,经血浆分离器清除后估算的4%枸橼酸钠速度(QCi#)的取值范围为27ml/h~32.4ml/h。
(3)计算血浆可提供的4%枸橼酸钠上限含量:
QCiP=QCi*-QCi#
计算得到:RCA-PE阶段血浆可提供的4%枸橼酸钠量(QCiP)的取值范围为35.1ml/h~54ml/h。
(4)计算血浆速度:
QP=QCiP×9(按照经验值取4%枸橼酸钠浓度为血浆中枸橼酸浓度的9倍),
计算得到:RCA-PE阶段血浆速度(QP)的取值范围为315.9ml/h~486ml/h。
按照上述实施例1的方法对相应的患者进行治疗,其各种参数与治疗效果如下表1所示:
表1按照实施例1的方法治疗时的参数取值和治疗效果
众所周知,无论是在RCA-CRRT阶段和RCA-PE阶段,其抗凝目标为体外离子钙<0.4mmol/L、枸橼酸蓄积诊断标准T/iCa>2.5,因此从表1可以看出,按照实施例1的方法选取各个参数值,其抗凝效果符合治疗要求。
实施例2
对体重10Kg的患者,设置RCA-CRRT阶段血泵速度(QB=50ml/min)和RCA-PE阶段血浆速度(QP=180ml/h),采用枸橼酸等量换算方法来计算RCA-PE阶段血泵速度,具体如下所示:
(1)计算RCA-CRRT阶段中进入身体的4%枸橼酸钠含量:
QCi*=QCi×(1-10%),其中QB×1.5≤QCi≤QB×1.8(其中QB和QCi分别以ml/min和ml/h为单位进行数值计算,),
计算得到:RCA-CRRT阶段4%枸橼酸钠速度(QCi)的取值范围为75ml/h~90ml/h,RCA-CRRT阶段假定的患儿枸橼酸耐受量(QCi*)的取值范围为67.5ml/h~81ml/h。
(2)计算RCA-PE阶段血浆中4%枸橼酸钠速度
QCiP=QP÷9,
计算得到:RCA-PE阶段血浆可提供的4%枸橼酸钠量(QCiP)为20ml/h。
(3)计算RCA-PE阶段经血浆分离器清除后可使用的4%枸橼酸钠上限量:
QCi&=QCi*-QCiP
计算得到:RCA-PE阶段经血浆分离器清除后可使用的4%枸橼酸钠上限量(QCi&)的取值范围为47.5ml/h~61ml/h。
(4)计算RCA-PE阶段4%枸橼酸钠速度:
QCi@=QCi&÷(1-10%),
计算得到:RCA-PE阶段4%枸橼酸钠速度(QCi@)的取值范围为52.8ml/h~67.8ml/h。
(5)计算RCA-PE阶段中血泵速度:
QCi@÷1.2≤QBP≤QCi@÷1.0,
计算得到:RCA-PE阶段血泵速度(QBP)的取值范围为44ml/h~67.8ml/h。
按照上述实施例2的方法对相应的患者进行治疗,其各种参数与治疗效果如下表2所示:
表2按照实施例2的方法治疗时的参数取值和治疗效果
参数取值 方法1 方法2 实施例1取值范围
QB/ml/min 50 50 50
QP/ml/h 180 180 180
QCi/ml/h 90 75 75~90
QCi*/ml/h 81 67.5 67.5~81
QCiP/ml/h 20 20 20
QCi& 61 47.5 47.5~61
QCi@/ml/h 52.8 67.8 52.8~67.8
QBP/ml/min 44 67.8 44~67.8
RCA-CRRT阶段体外离子钙浓度/mmol/L 0.28 0.31 /
RCA-CRRT阶段T/iCa 2.26 2.21 /
RCA-PE阶段体外离子钙浓度/mmol/L 0.29 0.29 /
RCA-PE阶段T/iCa 2.30 2.25 /
众所周知,无论是在RCA-CRRT阶段和RCA-PE阶段,其抗凝目标为体外离子钙<0.4mmol/L、枸橼酸蓄积诊断标准T/iCa>2.5,因此从表2可以看出,按照实施例2的方法选取各个参数值,其抗凝效果符合治疗要求。
综上所述,本发明公开了一种枸橼酸等量换算方法及其应用,主要通过RCA-CRRT中4%枸橼酸钠速度来计算PE中血浆速度或4%枸橼酸钠速度,在个体化桥接局部枸橼酸抗凝CRRT和PE中具有良好的应用效果,主要具有以下优点:(1)若RCA-PE前RCA-CRRT抗凝方案处于稳定状态且无枸橼酸蓄积,若经此方式序贯行RCA-PE,理论上RCA-PE将不会出现枸橼酸蓄积,因RCA-PE和RCA-CRRT枸橼酸总量大致相当;(2)可以保障RCA-PE全程的有效抗凝;(3)可以减少RCA-PE体内/外离子钙浓度的频繁监测;(4)可以有效的避免枸橼酸蓄积相关严重低钙血症等严重并发症。
最后说明的是,以上实施例仅用以说明本发明的技术方案而非限制,尽管参照较佳实施例对本发明进行了详细说明,本领域的普通技术人员应当理解,可以对本发明的技术方案进行修改或者等同替换,而不脱离本技术方案的宗旨和范围,其均应涵盖在本发明的权利要求范围当中。

Claims (2)

1.一种枸橼酸等量换算方法,其特征在于,所述枸橼酸等量换算方法具体为如下方案一或者方案二中的任意一种:
方案一,通过设置RCA-CRRT阶段血泵速度和RCA-PE阶段血泵速度来计算RCA-PE阶段中血浆速度,具体计算方法如下:
(1)计算RCA-CRRT阶段中进入身体的4%枸橼酸钠含量:
QCi*=QCi×(1-10%),其中QB×1.5≤QCi≤QB×1.8,
(2)计算RCA-PE阶段中4%枸橼酸钠进入身体的含量:
QCi#=QCi@×(1-10%),其中QBP×1.0≤QCi@≤QBP×1.2,
(3)计算血浆可提供的4%枸橼酸钠上限含量:
QCiP=QCi*-QCi#
(4)计算血浆速度:
QP=QCiP×9;
方案二,通过设置RCA-CRRT阶段血泵速度和RCA-PE阶段血浆速度来计算RCA-PE阶段血泵速度,具体计算方法如下:
(1)计算RCA-CRRT阶段中进入身体的4%枸橼酸钠含量:
QCi*=QCi×(1-10%),其中QB×1.5≤QCi≤QB×1.8,
(2)计算RCA-PE阶段血浆中4%枸橼酸钠速度
QCiP=QP÷9,
(3)计算RCA-PE阶段经血浆分离器清除后可使用的4%枸橼酸钠上限量:
QCi&=QCi*-QCiP
(4)计算RCA-PE阶段4%枸橼酸钠速度:
QCi@=QCi&÷(1-10%),
(5)计算RCA-PE阶段血泵速度:
QCi@÷1.2≤QBP≤QCi@÷1.0;
其中QCi为RCA-CRRT阶段4%枸橼酸钠速度、单位为ml/h,QCi*为RCA-CRRT阶段假定的患儿枸橼酸耐受量、单位为ml/h,QB为RCA-CRRT阶段血泵速度、单位为ml/min,QCiP为RCA-PE阶段血浆可提供的4%枸橼酸钠量、单位为ml/h,QP为RCA-PE阶段血浆速度、单位为ml/h,QCi#为RCA-QCi@经血浆分离器清除后估算的4%枸橼酸钠速度、单位为ml/h,QCi&为RCA-PE阶段经血浆分离器清除后可使用的4%枸橼酸钠上限量、单位为ml/h,QCi@为RCA-PE阶段4%枸橼酸钠速度、单位为ml/h,QBP为RCA-PE阶段血泵速度,单位为ml/min。
2.权利要求1所述枸橼酸等量换算方法在个体化桥接局部枸橼酸抗凝CRRT和PE的临床应用。
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