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APTTAPTT(秒)(秒)推注推注泵入速度泵入速度复测复测APTTAPTT(小时)(小时) 40 65.0 65.0停停1hr1hr,并,并- 200 - 200 U/hrU/hr4h4hJ Crit Care 20:155161, 2005Van Der Voort PH, Blood Purif (2005) 23:175180 Oudemans-van Straaten HM, Intensive Care Med (2006) 32:188202. Van Der Voort PH, Blood Purif (2005) 23:175180 Oudemans-van Straaten HM, Intensive Care Med (2006) 32:188202. Kutsogiannis DJ, Gibney RTN, Stollery D et al. Regional citrate versus systemic heparin anticoagulation for continuous renal replacement in critically ill patients. Kidney Int 2005; 67: 2361-2367hospital and 3-month mortality rates were 15% lower in the citrate than in the nadroparin groupcitrateHeleen M. Crit Care Med,2009 , 37( 2):545-552.Oudemans-van .Intensive Care Med (2006) 32:188202 RheaterACD-AVVPVPAUFBLDSAD枸橼酸钙动脉标本动脉标本外周静脉或动脉外周静脉或动脉游离钙游离钙1.10 1.30 mmol/L静脉标本静脉标本滤器后血滤管路滤器后血滤管路游离钙游离钙0.25 0.35 mmol/LQ2h x 4Q4h x 4Day 1Day 2Q 6 8 h橼酸根据滤器后离子钙水平橼酸根据滤器后离子钙水平, ,10%葡萄糖酸钙根据外周葡萄糖酸钙根据外周血离子钙水平调整血离子钙水平调整滤 器 后 离 子滤 器 后 离 子钙钙枸橼酸枸橼酸外周离子钙外周离子钙10%葡萄糖酸葡萄糖酸钙钙0.20降低降低5ml/h1.45降低降低6ml/h0.20-0.40不变不变1.21-1.45降低降低3ml/h0.41-0.50增加增加5ml/h1.00-1.20不变不变0.50增加增加10ml/h0.90-1.00增加增加3ml/h0.90推注推注0.3ml/kg,增加增加6ml/h外源性凝血途径组织损伤内源性凝血途径XIIXIIaXIXIaIXIXaVIICa+血小板因子3组织因子VIICa+VII-Ca+IXa-Ca+-VIII血小板因子3 磷脂 XaX凝血酶凝血酶凝血酶原纤维蛋白纤维蛋白原VCa+磷脂凝血酶抑凝血酶抑制剂制剂Murray PT, Kidney Int 2004; 66:24462453.Andreas Link, Crit Care Med 2009. 37( 1):105-110.危重患者危重患者CRRTCRRT时时argatrobanargatroban给药速度与患者给药速度与患者吲吲哚花青绿哚花青绿清除率线性相关清除率线性相关Andreas Link, Crit Care Med 2009. 37( 1):105-110危重患者危重患者CRRTCRRT中,中, argatrobanargatroban给药速度与给药速度与APACHEAPACHE II II 积分明显相关。积分明显相关。Andreas Link, Crit Care Med 2009. 37( 1):105-110
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