The Clinical Application Of Heparin Dosing Algorithm In Continuous Blood Purification Therapy

BACKGROUND&OBJECTIVE:With the development of continuous blood purification?CBP?technology in recent years,research and development of various anticoagulant methods and anticoagulants for CBP processes have become more and more important.Earlier,our team established three models to predict the rational anticoagulant dose of heparin,the first is a deep neural network model?Deep belief networks,DBN?,the second is multiple linear regression?MLR?with multiple coagulation indicators,and the third is a linear regression?ALR?model which is based weight.This study intends to further evaluate the advantages and disadvantages of the three methods for daytime continuous venous hemofiltration with anticoagulation by prospective study,and to explore more optimized and accurate management of heparin use,which may help reduce or avoid the occurrence of anticoagulant adverse events during blood purification treatment.METHODS:This was a prospective,single-blind,and randomized controlled trial.Patients were treated in the Department of Nephrology at the Second Hospital Affiliated to Dalian Medical University from January 2018 to December 2018 for daytime continuous venous hemofiltration?CVVH?were included in the study.According to the inclusion and exclusion criteria,the selected patients were randomly divided into 3 groups according to the single-blind method.A total of 120 patients were randomly assigned into three groups of N₀ group?ALR linear regression equation model group,n=40?,N₁ group?MLR multiple linear regression equation model group,n=40?and N₂ group?DBN artificial neural network model group,n=40?.The N₀ group was given the first heparin dose and the additional dose calculated by the ALR model before treatment.The heparin dose in the N₁ group was calculated by MLR model.And the dose of heparin calculated by the DBN was given before the test in the N₂ group.The indicators of Blood clot before treatment and 2 hours after treatment were recorded,and the duration of hemofiltration treatment was observed.The coagulation grade of extracorporeal circuit,filter and intravenous pot coagulation were observed.Compare the anticoagulant effectiveness among the three groups?whether there is coagulation in filter,blood coagulation level and blood filter life?,safety?changes in coagulation parameters such as activated partial thromboplastin time and platelet count before and after treatment?,bleeding or metabolic complications?The incidence of bleeding in the femoral vein/jugular puncture site,digestive tract and skin mucosa within 48 hours;The blood gas analysis and electrolyte changes?.RESULTS:There were significant differences in the coagulation grade of filter among the N₀,N₁,and N₂ groups?P<0.05?,and the coagulation grade of filter in the N₂ group was significantly lower than that of the N₀ and N₁ groups,the difference was statistically significant?P<0.05?.The duration of hemofiltration treatment in the N₀ group?7.59±1.18h?was significantly lower than that of N₁?8.26±1.18h?and N₂ group?8.21±1.09h??P<0.05?,but there was no statistically significant difference in the duration of hemofiltration between N₁ and N₂ groups?P>0.05?.Kaplan-Meier curve was performed for the duration of hemofiltration in the three groups.The results showed that there were significant differences in the duration of the three groups of total hemofiltration?P<0.05?,and the duration of treatment in the N₂ group was significantly longer than that in the N₀ group?P<0.05?.There were no significant differences in the total dose of heparin among N₀,N₁ and N₂ groups?P>0.05?.There were no significant differences in the biochemical parameters such as activated partial thromboplastic time,platelet count,hemoglobin and creatinine in the N₀,N₁ and N₂ groups before treatment?P>0.05?.The parameters of PT-T,PT%,PT-R,APTT,and TT before treatment were significantly different compared with those 2 hours after treatment in the N₀ group?P<0.05?.The level of PT-T,PT%,INR and APTT were significantly different between pre-treatment and those 2 hours after treatment?P<0.05?in N₁group.The level of APTT and TT were significantly different between pre-treatment and 2 hours after treatment in N₂ group?P<0.05?.There were no significant differences in PT-R,Fbg,APTT and TT among the three groups?P>0.05?.There were3 cases of hemorrhagic complications in the N₀ group,the incidence rate was 7.5%,compared with the N₁ and N₂ groups,the difference was not statistically significant?P>0.05?.One case of thrombocytopenia occurred both in N₀ and N₁ groups,and no cases in N₂ group.There were no significant differences in the incidence of hypocalcemia and hyponatremia among the three groups?P>0.05?.Conclusion:The validity and safety in the patients with heparin dose calculated by DBN model are more superior than MLR model and the ALR model depended on weight.