摘要
目的研究伴高乳酸血症的重症患者行局部枸橼酸抗凝(CRA)-连续性肾脏替代(CRRT)治疗的有效性和安全性。方法收集2021年10月-2023年3月于新疆医科大学第一附属医院呼吸重症监护室进行RCA-CRRT治疗的67例伴高乳酸血症(2 mmol/L<乳酸值<10 mmol/L)的重症患者临床资料,按局部抗凝方式分为对照组(低分子肝素抗凝)20例和CRA组(枸橼酸抗凝)47例。收集患者一般资料及CRRT治疗前及治疗24 h患者乳酸值、pH值、碳酸氢根离子(HCO_(3)^(-))、滤器后血清离子钙(iCa^(2+))、体内iCa^(2+)、血清总钙、血钠离子(Na+)、镁离子(Mg^(2+));统计滤器结局、血液制品输注情况、出血事件发生率及死亡率,记录CRA相关并发症发生情况。结果两组一般资料比较,差异均无统计学意义(P>0.05);与本组治疗前比较,CRRT治疗24 h两组乳酸值水平均降低,iCa^(2+)、pH、HCO3-水平升高(P<0.05);CRRT治疗24 h后,两组患者总钙、总钙/iCa^(2+)比值、Na+、Mg^(2+)水平比较,差异均无统计学意义(P>0.05)。与对照组比较,CRA组滤器平均使用寿命延长,差异有统计学意义(P<0.05),两组治疗期间出血事件发生率、血液制品输注情况、死亡率差异均无统计学意义(P>0.05);两组患者治疗24 h滤器或管路凝血发生率等级分布比较,差异有统计学意义(P<0.05),且CRA组Ⅱ/Ⅲ级凝血发生率低于对照组(P<0.05);两组患者枸橼酸蓄积、代谢性酸中毒、代谢性碱中毒发生率及总并发症发生率比较,差异无统计学意义(P>0.05)。结论伴高乳酸血症的重症患者行CRA-CRRT治疗有助于降低血乳酸水平,纠正酸中毒,减少凝血和出血风险,延长滤器寿命,枸橼酸蓄积风险低。
Objective To investigate the efficacy and safety of local citric acid anticoagulation(CRA)and continuous renal replacement therapy(CRRT)in severe patients with hyperlactacemia.Methods The clinical data of 67 severe patients with hyperlactacemia(2 mmol/L<lactic acid value<10 mmol/L)who were treated with RCA-CRRT in the Respiratory intensive Care Unit of the hospital from October 2021 to March 2023 were collected.The patients were divided into control group(low molecular weight heparin anticoagulation)20 cases and CRA group(citric acid anticoagulation)47 cases.General data and lactic acid value,pH value,bicarbonate ion(HCO_(3)^(-)),post-filter serum calcium(iCa^(2+)),in vivo iCa^(2+),serum total calcium,serum sodium(Na+),magnesium(Mg^(2+))were collected before and 24 h after CRRT treatment.Filter outcomes,blood product transfusions,bleeding event rates and mortality were counted and CRA-related complications were recorded.Results There was no significant difference in general data between the 2 groups(P>0.05).Compared with this group before the treatment,lactic acid levels were decreased and iCa^(2+),pH and HCO_(3)^(-) levels were increased in both groups after 24 hours of CRRT treatment(P<0.05).After 24 hours of CRRT treatment,there were no significant differences in total calcium,total calcium/iCa^(2+)ratio,Na+and Mg^(2+)levels between the 2 groups(P>0.05).Compared with the control group,the average service life of the filter in the CRA group was extended(P<0.05),and there were no significant differences in the incidence of bleeding events,blood product infusion and mortality between the 2 groups during treatment(P>0.05).There was statistical significance in the grade distribution of colter or tube clotting incidence between the 2 groups after 24 hours treatment(P<0.05),and the gradeⅡ/Ⅲclotting incidence in the CRA group was lower than that in the control group(P<0.05).There was no significant difference in the incidence of citric acid accumulation,metabolic acidosis,metabolic alkalosis and total complications between the 2 groups(P>0.05).Conclusion In severe patients with hyperlactacemia,CRA-CRRT treatment is helpful to reduce blood lactic acid level,correct acidosis,reduce the risk of coagulation,extend the filter life,do not increase the risk of bleeding and bleeding,prolong filter life and lower the risk of citric acid accumulation.
作者
杜国伦
李超
张红丽
DU Guolun;LI Chao;ZHANG Hongli(Respiratory Intensive Care Unit,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《新疆医科大学学报》
CAS
2024年第1期51-56,共6页
Journal of Xinjiang Medical University
基金
新疆维吾尔自治区自然科学基金项目(2020D01E253)。
关键词
连续性肾脏替代治疗
局部枸橼酸抗凝
高乳酸血症
有效性
安全性
continuous renal replacement therapy
regional citrate anticoagulation
lactacidosis
validity
security
