The Development Of A Rating Table For The Capacity Status Of Patients In Continuous Renal Replacement Therapy (CRRT) And Clinical Empirical Research

Purpose：1．Develop a rating table for the capacity status of patients in continuous renalreplacement therapy (CRRT).2．Explore the functions of this rating table in evaluating the the capacity status ofpatients in continuous renal replacement therapy (CRRT) and in guiding theadjustment of ultrafiltration volume.Methods:1. Set the outline of this rating table for the capacity status of patients in continuousrenal replacement therapy (CRRT) on evidence-based basis. Then, after two roundsof public consultation on the eight experts through the Delphi method (Delphi),indicators were sorted, analysed, quantized, and scored according to the discussion ofthe experts. Thus, the rating table for the capacity status of patients in continuousrenal replacement therapy (CRRT) established.2．Convenience sampling method used,46Critical ill patients in medical ICU andsurgical ICU of a three level of first-class hospital in Fujian Province from September2012to February2013were selected. The patients were divided into two groups: thePiCCO monitoring group with16cases and the ordinary monitoring group with30cases. Relevant datas were collected at the beginning of CRRT, and at the2h、4h、6h、8h、10h、12h during treatment process；One case was defined when the patientreplaced his filter after12hours’ treatment. During it, elevant datas were observed andrecorded. Evaluate the capacity status of those patients by this rating table and adjustthe ultrafiltration volume according to the patients’ goal ultrafiltration volume. Basedon it, evaluated capacity situation of the patients every2hours, which meant declinedthe ultrafiltration volume per hour when patient’ s score increased due to hypovolemia, and increased the ultrafiltration volume per hour if the situation was the opposite.Utrafiltration volume was controlled from0-500ml according to different patients.Descriptive statistics, analysis of variance, T test, correlation analysis was used forstatistics.Results:1．Form a rating table for the capacity status of patients in continuous renalreplacement therapy (CRRT), which includes hemodynamic monitoring、PiCCOcapacity indicators、Drug use、clinical symptoms four dimensions. Hemodynamicmonitoring has three entries, including heart rate, blood pressure, central venouspressure. PiCCO capacity indicators include GEDVI, ITBVI, EVLWI, SVI, and CI5entries. Dug use includes dopamine、epinephrine, norepinephrine and dobutamine4entries. Clinical symptoms include lung wet rales, edema, and jugular veindistention3entries.2．The ordinary monitoring group scored the patients’ capacity status by rating tablefor the capacity status of patients in continuous renal replacement therapy (CRRT),and adjusted the ultrafiltration volume according to the score result. Comparison inheart rate and blood pressure before and after treatment showed that there was nostatistical differences (P＞0.05). The comparison in Central venous pressure beforeand after treatment showed statistical significance (P=0.025). The comparison inscores before and after treatment had statistical significance (P=0.00). The correlationanalysis of the patients’ heart rate, blood pressure and ultrafiltration volume in thisgroup showed there is no statistical significance (P＞0.05). The correlation analysisof patients’ Central venous pressure and ultrafiltration volume had statisticalsignificance (P=0.003; Correlation=-0.220). The correlation analysis of the patients’ scores and ultrafiltration volume had statistical significance (P=0.036; Correlation=0.156). After treatment, Patients’ cases of abnormalities in heart rate in this groupdeclined from8to7; the cases of dysarteriotony declined from7to1; the cases ofCentral venous anomalies declined from21to10. The use of Vasoactive drugs: Aftertreatment, the dmean of dopamine declined from5.5ml/h to4.2ml/h; the dmean of epinephrine declined from6.83ml/h to5.58ml/h.3. The PiCCO monitoring group scored the patients’ capacity status by rating tablefor the capacity status of patients in continuous renal replacement therapy (CRRT),and adjusted the ultrafiltration volume according to the score result. Comparison inheart rate, blood pressure, central venous pressure, GEDVI、ITBVI、SVI、CI beforeand after treatment showed that there was no statistical differences (P＞0.05). Thecomparison in Extravascular Lung Water Index (EVLWI) before and after treatmenthad statistical significance (P=0.008). The comparison in scores before and aftertreatment had statistical differences (P=0.013). The correlation analysis of thepatients’ heart rate, blood pressure, central venous pressure, GEDVI、ITBVI、SVI、CI and ultrafiltration volume had no statistical significance (P＞0.05). The correlationanalysis of the patients’ scores and ultrafiltration volume had statistical significance(P=0.006; Correlation=-0.277). The correlation analysis of the patients’ GEDVI andultrafiltration volume had statistical significance (P=0.00; Correlation=-0.514). Thecorrelation analysis of the patients’ ITBVI and ultrafiltration volume had statisticalsignificance (P=0.00; Correlation=-0.514). After treatment, Patients’ cases ofabnormalities in heart rate in this group declined from6to3; the cases ofdysarteriotony declined from3to2; the cases of GEDVI declined from9to8; thecases of ITBVI declined from9to8; the cases of EVLWI declined14to10; the casesof SVI declined8to7; the cases of CI declined2to1. The use of Vasoactive drugs:After treatment, the use of epinephrine declined from3cases to2cases.Conclusion：1. The establishment of this rating table for the capacity status of patients incontinuous renal replacement therapy (CRRT) was reasonable，which followedevidence-based theory. This rating table can evaluate the capacity status of thepatients in continuous renal replacement therapy (CRRT) comprehensively, so thissheet can serve clinical medical staffs.2．After12hours’ continuous renal replacement therapy (CRRT), both two groups’ related indicators of hemodynamics tends to nomal range; the cases of the patientswhose related indicators of hemodynamics were abnomal had different decrease; the cases and dmean use of Vasoactive drugs also had different decrease. All theseproved that this rating table can evaluate the capacity status of patients in continuousrenal replacement therapy (CRRT) correctly and guide the adjustment ofultrafiltration volume timely and accurately.