摘要
目的观察使用含钙透析液和置换液的局部枸橼酸抗凝(regional citrate anticoagu-lation,RCA)技术在连续性肾脏替代治疗(continuous renal replacement treatment,CRRT)中的安全性及有效性。方法前瞻性收集2020年1月—2021年12月在四川大学华西医院行CRRT的患者,采用枸橼酸抗凝方案的连续性静脉-静脉血液透析滤过(continuous veno-venous haemodiafiltra-tion,CVVHDF)模式。血管通路采用颈内/股静脉留置双腔导管,起始血流量为150 ml/min,含钙透析液和置换液速度均为1000 ml/h,4%枸橼酸钠溶液以180 ml/h的起始速度泵入。治疗过程中分别在0、6、12、24、48小时测定滤前及滤后游离钙水平,收集体外循环管路寿命、治疗参数以及并发症等。结果共纳入28例患者,44例次体外循环管路,42例次按计划CRRT,平均体外循环管路寿命为(44.0±24.6)h,体外循环管路寿命<24小时共11例(26.2%),24小时≤体外循环管路寿命<48小时共13例(31.0%),48小时≤体外循环管路寿命≤72小时共18例(42.9%)。治疗6小时(t=0.612,P=0.969)、12小时(t=0.456,P=0.625)、24小时(t=0.848,P=0.298)、48小时(t=0.411,P=0.415)滤前钙离子水平与基线(0小时)外周血游离钙离子比较均无统计学差异。治疗6小时(t=0.294,P=0.774)、12小时(t=0.246,P=0.405)、24小时(t=0.191,P=0.853)、48小时(t=0.059,P=0.955)滤后钙离子水平与基线(0小时)滤后钙离子比较均无统计学差异。1例次(2.3%)患者出现代谢性碱中毒,1例次(2.3%)出现枸橼酸蓄积。结论采用含钙透析液和置换液的RCA技术在CRRT中是安全且有效的,适用于含一体化枸橼酸抗凝系统的CRRT设备,值得临床进一步推广应用。
Objective To observe the effectiveness and safety of calcium-containing dialysate and re-placement fluid with regional citrate anticoagulation in continuous renal replacement treatment(CRRT).Methods We prospectively recruited the patients treated with CRRT in West China Hospital of Sichuan Uni-versity during January 2020 to December 2021.They were treated with the model of continuous veno-venous hemodiafiltration(CVVHDF)using citrate anticoagulation method.Blood access used the cuffed catheter in internal jugular vein or femoral vein.The initial blood flow was 150 ml/min,the rate of calcium-containing di-alysate and replacement fluid was 1,000 ml/h,and 4%sodium citrate solution was pumped at the initial rate of 180 ml/h.Calcium ion was measured before and after the filtration at 0h,6h,12h,24h and 48h.Lifespan of the extracorporeal circulation pipeline,treatment parameters and complications were collected.Results A to-tal of 28 patients were enrolled in this study,including 44 times of extracorporeal circulation pipeline and 42 times of scheduled CRRT.The average lifespan of the extracorporeal circulation pipeline was 44.0±24.6h,in-cluding the lifespan of<24h in 11 cases(26.2%),24h~<48h in 13 cases(31.0%),and 48h~≤72h in 18 cases(42.9%).There were no significant differences in the levels of calcium ion before filtration at 6h(t=0.612,P=0.969),12h(t=0.456,P=0.625),24h(t=0.848,P=0.298)and 48h(t=0.411,P=0.415),as compared with the baseline level at 0h.There were also no significant differences in the levels of calcium ion after filtra-tion at 6h(t=0.294,P=0.774),12h(t=0.246,P=0.405),24h(t=0.191,P=0.853)and 48h(t=0.059,P=0.955),as compared with the level at 0h.Metabolic alkalosis was found in one patient(2.3%),and citric acid accumu-lation was found in one patient(2.3%).Conclusion The calcium-containing dialysate and replacement fluid with regional citrate anticoagulation for CRRT is effective and safe,and is suitable for the use of CRRT equip-ment with integrated citrate anticoagulation system.This method is worthy of further clinical application.
作者
强靖雅
唐雪
王芳
王蓓蓓
陈芳
陈志文
张凌
QIANG Jing-ya;TANG Xue;WANGFang;WANG Bei-bei;CHEN Fang;CHEN Zhi-wen;ZHANG Ling(Department of Nephrology,West China Hospital of Sichuan University,Chengdu 610041,China)
出处
《中国血液净化》
2025年第1期31-34,共4页
Chinese Journal of Blood Purification
关键词
含钙置换液
枸橼酸抗凝
连续性肾脏替代治疗
Calcium-containing replacement fluid
Citrate anticoagulant
Continuous renal replacement therapy
