连续性肾脏替代治疗患者含钙置换液局部枸橼酸抗凝管理的最佳证据总结

doi:10.3761/j.issn.2096-7446.2026.11.017

摘要/Abstract

摘要：

目的检索、评价并综合含钙置换液的局部枸橼酸抗凝的连续性肾脏替代治疗（regional citrate anticoagu-lation-continuous renal replacement therapy，RCA-CRRT）患者抗凝管理的相关证据。方法系统检索国内外数据库、指南网、相关专业网站中关于含钙置换液的RCA-CRRT治疗患者抗凝管理的指南、系统评价、证据总结、专家共识、临床决策。检索时限为建库至2025年6月1日。由2名研究者独立进行文献质量评价和证据提取。结果共纳入14篇文献，包括指南3篇、专家共识4篇、证据总结4篇、系统评价1篇、临床决策2篇。汇总、提取了包括治疗前评估、管路预充、实施要点、实施过程监测与注意点、并发症观察与处理、下机指征和封管液选择等7个方面的24条最佳证据。结论该研究总结了含钙置换液的RCA-CRRT患者抗凝管理的最佳证据，可为医护人员开展循证实践提供依据。

关键词: 连续性肾脏替代治疗, 局部枸橼酸抗凝, 证据总结, 循证护理学, 含钙置换液

Abstract:

Objective To retrieve，evaluate and synthesize the relevant evidence on the anticoagulation management of patients with regional citrate anticoagulation continuous renal replacement therapy（RCA-CRRT） using calcium-containing replacement solution. Methods Domestic and foreign databases，guideline websites，and relevant professional websites were systematically searched for guidelines，systematic reviews，evidence summaries，expert consensus，and clinical decision-making on the anticoagulation management of patients treated with RCA-CRRT using calcium-containing replacement solutions. The search time limit was from the establishment of the database to June 1，2025. Two researchers independently performed literature quality appraisal and evidence extraction. Results A total of 14 articles were included，including 3 guidelines，4 expert consensuses，4 evidence summaries，1 systematic review，and 2 clinical decision-making. The 24 pieces of best evidence were summarized and extracted，including 7 aspects including pre-treatment evaluation，tubing pre-filling，implementation points，implementation process monitoring and attention points，complication management，selection of sealing fluid and indications for terminating treatment. Conclusion This study summarizes the best evidence for anticoagulation management in RCA-CRRT patients with calcium-containing replacement solution，and can provide corresponding guidance for medical staff to implement evidence-based practices.

Key words: Continuous Renal Replacement Therapy, Regional Citrate Anticoagulation, Evidence Summary, Evidence-Based Nursing, Calcium-Containing Replacement Solutions

王盈, 戴秋红, 王素梅, 关纯. 连续性肾脏替代治疗患者含钙置换液局部枸橼酸抗凝管理的最佳证据总结[J]. 中华急危重症护理杂志, 2026, 7(11): 1377-1383.

WANG Ying, DAI Qiuhong, WANG Sumei, GUAN Chun. Summary of best evidence for anticoagulant management of patients with regional citrate anticoagulation-continuous renal replacement therapy using calcium-containing replacement solutions[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(11): 1377-1383.

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