| ObjectsObserve saline flushes and no-rinse methods on the state of various pressures, patient platelets, coagulation, heart rate, blood pressure in critically ill patients with high risk of bleeding during CRRT without anticoagulation. Explore a safe and effective anticoagulation method for CRRT without anticoagulation. Investigate the effect on blood coagulation, circulation and filter life for critically ill patients with high bleeding risk requiring CRRT without anticoagulation. Explore a safe and effective anticoagulation method for CRRT without anticoagulation. Provide an objective basis for the improvement of CRRT without anticoagulation practices.MethodsChoose 43 patients with high risk of bleeding requiring CRRT without anticoagulation in the ICU of Nephrology at PLA General Hospital. They were randomly divided into two groups, including saline flushes group and no-rinse group. CRRT was performed using the Prismaflex CRRT machine together with and M100 filter(Jinbao company, Sweden). Previous treatment,4mg/dl heparin saline was pre-impulsed, retention perfused for 20 minutes, and then rinsed with normal saline 500ml. In the saline flushes group,100ml of 0.9% sodium chloride was infused via the arterial line and rapidly flushed through the extracorporeal system and filter every 60min of CRRT while occluding the blood inlet line. In the no-rinse group, no solution was flushed during the treatment. At the start of CRRT, before start of ultrafiltration, and after 1,3 and 6h of CRRT the following blood specimens were taken from the arterial line to measure the levels of prothrombin fragment 1+2 and b-thromboglobulin.All blood specimens were taken after lowering the blood flow to 100 ml/min for 1 min. During CRRT with saline flushes, blood specimens were drawn immediately before the next saline flush. The transmembrane pressure, before the filter pressure and the filter pressure decrease value were observed at the start of CRRT, after 1,2,3, and 4h of CRRT, and in the end of CRRT.Changes on HR, SBP, DBP, MBP and pulse pressure were observed at the start of CRRT, after 1,2,3,4 and 5h of CRRT, and in the end of CRRT.Results1. Coagulation and platelet function changes In two groups, changes on PF1+2 and β-TG showed no significant change. The trends on changes of PF1+2 and β-TG are similar, there was no significant difference between the two groups.2. Pressure changes on CRRT There were significant improvements on the transmembrane pressure and the filter pressure decrease value after 4h of CRRT and in the end of CRRT (P<0.01). Changes on the filter pressure showed no significant change. TMP, PBE, ΔP showed no significant change between two groups.3. Halfway back to the blood under machine conditionsIn saline group, there were 2 cases (10.00%) halfway back, including one case (5.00%) was due to the transmembrane pressure high alarm when after 5h ofCRRT, and one (5.00%) was due to going out for temporary CT examination. In no-rinse group,5 patients (21.74%) were halfway back, including one case (4.35%) was due to the transmembrane pressure high alarm after 5h and 10min of CRRT, two cases (8.70%) was due to transmembrane pressure high alarm after 6.5h of CRRT, one case (4.35%) was due to transmembrane pressure rising to 310mmHg after 8h of CRRT, one case (4.35%) due to was low blood pressure to 87/42mmHg after 4h of CRRT. The CRRT time in two groups of patients who were halfway back due to the pressure high alarm were all more than 5 hours. The number of cases in saline flushes group who were halfway back due to the pressure high alarm was less than cases in no-rinse group. The remaining patients all followed doctor’s orders and completed theCRRT for 6-10h.4.The heart rate, blood pressure changesIn two groups, heart rate and blood pressures showed no significant change. At different time, there was no significant difference on heart rate, SBP,DBP and MBP between the two groups, however, there was a significant difference on pulse pressure at 2h,3h,4h,5h and in the end of CRRT between the two groups.ConclusionWhen a acute or chronic renal patient with high risk of bleeding requiring CRRT without anticoagulation, if he was disastered by cardiovascular disease, no-rinse method was recommended, if he was in good cardiovascular function, saline flushes sould be applied after 5h of CRRT to extend the life of the filter. |
