摘要
目的观察局部枸橼酸抗凝(regional citrate anticoagulation,RCA)在连续肾脏替代疗法(continuous renal replacement therapy,CRRT)串联人工肝治疗中的运用效果和安全性。方法收集2019年12月至2023年6月我中心收治的21例慢加急性肝衰竭(acute on chronic liver failure,ACLF)合并急性肾损伤(acute kidney injury,AKI)的患者行RCA的CRRT串联人工肝治疗54例次的临床资料,观察分析治疗前后肝肾功能指标改善情况、枸橼酸的抗凝效果和不良反应以及患者转归。结果54例次的CRRT串联人工肝治疗前后肝肾功能指标均有改善,差异有统计学意义(P<0.05);累计54例次的CRRT串联人工肝治疗均顺利完成,体外循环管路、滤器及吸附器未发现明显血凝块;所有例次患者体内总钙与离子钙水平在人工肝治疗各阶段与治疗前的比较,差异无统计学意义(P>0.05);但其中3例次CRRT串联PE和1例次CRRT串联DPMAS+LPE的患者治疗后发生枸橼酸蓄积,通过及时纠正和补充24 h后均恢复正常;21例患者30 d生存率:存活13例,死亡5例,自动出院3例。结论在严密监测和及时调整的情况下RCA在CRRT串联人工肝治疗中的运用安全可行,值得临床推广。
Objective To observe the effectiveness and safety of Regional Citrate Anticoagulation(RCA)in CRRT combined with artificial liver treatment.Methods Clinical data of 54 sessions of CRRT linked with artificial liver treatment using RCA in 21 patients with acute on chronic liver failure(ACLF)combined with acute kidney injury(AKI)admitted to our center from December 2019 to June 2023 were collected..The improvement of liver and kidney function indicators,anticoagulant effect and adverse reactions of citric acid,and patient outcomes were observed and analyzed before and after treatment.Results The 54 cases of liver and renal function indexes were improved,which showed a statistically significant difference(P<0.05);All 54 cases of CRRT linked artificial liver treatment were successfully completed,and no obvious blood clots were found in the extracorporeal circulation tubing,filters,and adsorbers;There was no statistically significant difference(P>0.05)in the total calcium and ionized calcium levels of all patients at each stage of artificial liver treatment compared to before treatment;However,three cases of CRRT combined with PE and one case of CRRT combined with DPMAS+LPE experienced citrate accumulation after treatment,which returned to normal after 24 hours of timely correction and supplemen-tation;The 30-day survival rate of the 21 patients was 13 survivors,5 deaths,and 3 discharged automatically.Conclusion Under strict monitoring and timely adjustment,the application of RCA in CRRT series artificial liver treatment is safe and feasible,and is worthy of clinical promotion.
作者
金玉峰
申存毅
张靖垚
薛玉龙
何栋
JIN Yufeng;SHEN Cunyi;ZHANG Jingyao;XUE Yulong;HE Dong(The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)
出处
《实用医学杂志》
CAS
北大核心
2024年第13期1879-1884,共6页
The Journal of Practical Medicine
基金
国家自然科学基金项目(编号:82072145)
西安交通大学第一附属医院基金项目(编号:2022HL-20)。
