Objective To investigate the anticoagulant effect and safety of two-stage regional citrate anticoagulation regimen used in daytime continuous renal replacement therapy with calcium-containing replacement fluid. Methods A total of 96 patients who received daytime renal replacement therapy in a tertiary hospital in Wuhan were selected and randomly divided into experimental group and control group by 2:1. Two-stage citrate anticoagulation regimen was used in experimental group and traditional citrate anticoagulation regimen was used in control group. The incidence of tube plugging,coagulation grade of the filter and vein pot after disoperation,calcium ion concentration 2 h after beginning,and relative blood gas index and total calcium/ionic calcium ratio at the end of treatment were compared between the two groups. Results The incidence of tube plugging in the experimental group was lower than that in the control group,the difference was statistically significant（χ2=4.980,P<0.05）. The coagulation grade of the vein pot in the experimental group was significantly better than the control group,the difference was statistically significant（Z=3.556,P<0.001）.The 2 h venous calcium concentration of experimental group was lower than that of control group,and the difference was statistically significant（t=7.418,P<0.001）. At the end of treatment,the relevant blood gas markers in both groups were within the normal range,total calcium/ionic calcium<2.5,the difference was not statistically significant（P>0.05）. Conclusion Two-stage regional citrate anticoagulation can reduce the incidence of tube clotting in continuous renal replacement therapy with calcium replacement fluid and improve the anticoagulant effect of vein pot. At the same time,the scheme does not increase the risk of citrate accumulation,so it is a safe anticoagulant choice.
WU Huijun
,
TONG Hui
,
ZHANG Zhonghua
,
WANG Lisheng
,
YAN Jianjun
. Application of two-stage citrate anticoagulation in continuous daytime renal replacement therapy with calcium replacement fluid[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023
, 4(3)
: 197
-201
.
DOI: 10.3761/j.issn.2096-7446.2023.03.001
[1] Kellum JA,Ronco C.The 17 th acute disease quality initiative international consensus conference:introducing precision renal replacement therapy[J]. Blood Purif,2016,42(3):221-223.
[2] 张勇. 持续性肾脏替代治疗的临床过程安全管理研究[D]. 沈阳:中国医科大学,2020.
Zhang Y.Safety management of clinical process of continuous renal replacement therapy[D]. Shenyang:China Medical University,2020.
[3] 张继强,张燕,陈卫东,等. 日间CRRT在治疗高龄AKI患者中的临床效果研究[J]. 国际泌尿系统杂志,2014,34(4):493-496.
Zhang JQ,Zhang Y,Chen WD,et al.The clinic effect of daytime CRRT in the treatment of elderly patients with acute kidney injury[J]. Int J Urol Nephrol,2014,34(4):493-496.
[4] Khwaja A.KDIGO clinical practice guidelines for acute kidney injury[J]. Nephron Clin Pract,2012,120(4):c179-c184.
[5] 血液净化急诊临床应用专家共识组. 血液净化急诊临床应用专家共识[J]. 中华急诊医学杂志,2017,26(1):24-36.
Expert Consensus Group on Emergency Clinical Application of Blood Purification. Expert consensus on emergency clinical appli-cation of blood purification[J]. Chin J Emerg Med,2017,26(1):24-36.
[6] 阳柳,吴欣,李晓颖,等. 两段式枸橼酸抗凝在普通血液透析的效果[J]. 实用医学杂志,2020,36(23):3260-3263,3268.
Yang L,Wu X,Li XY,et al.Observation of the effect of two-stage citrate anticoagulation in hemodialysis[J]. J Pract Med,2020,36(23):3260-3263,3268.
[7] 陈香美. 血液净化标准操作规程-2021[M]. 北京:人民卫生出版社,2021.
Chen XM.Blood purification standard operating procedure (SOP)[M]. Beijing:People's Medical Publishing House,2021.
[8] 徐丽珍,潘利飞. 局部枸橼酸抗凝的CRRT治疗中管路采血对血气分析结果的影响[J]. 护士进修杂志,2020,35(1):77-80.
Xu LZ,Pan LF.The effect of blood collection by pipeline on blood gas analysis in CRRT with local citrate anticoagulation[J]. J Nurs Train,2020,35(1):77-80.
[9] Cheng YL,Yu AW,Tsang KY,et al.Anticoagulation during haemodialysis using a citrate-enriched dialysate:a feasibility study[J]. Nephrol Dial Transplant,2011,26(2):641-646.
[10] Bi X,Zhang Q,Zhuang F,et al.Optimized calcium supplementation approach in post-dilution CVVHDF using regional citrate anticoagulation[J]. Int J Artif Organs,2021,44(3):165-173.
[11] 杨晓晨. 分段式枸橼酸抗凝在连续静脉-静脉血液透析滤过中的应用及效果评价[D]. 长春:吉林大学,2021.
Yang XC.Application and effect evaluation of segmented citrate anticoagulation in continuous veno-venous hemodiafiltration[D]. Changchun:Jilin University,2021.
[12] 韩锦,王欣,李侠,等. 枸橼酸盐两段式抗凝在含钙置换液连续性肾脏替代治疗中的抗凝效果[J]. 山西医科大学学报,2019
50(12):1750-1754.
Han J,Wang X,Li X,et al.Anticoagulation effect of two-stage citrate anticoagulation in continuous renal replacement therapy with calcium-containing replacement solution[J]. J Shanxi Med Univ,2019,50(12):1750-1754.
[13] 刘钊,曾一千,袁娇,等. 实施简化枸橼酸抗凝后稀释连续性静脉-静脉血液透析滤过治疗时滤后游离钙靶目标校正的研究[J]. 临床肾脏病杂志,2022,22(3):209-213.
Liu Z,Zeng YQ,Yuan J,et al.Post-filter ionized calcium target adjusted during simplified regional citrate anticoagulation during postdilution continuous veno-venous hemodiafiltration therapy[J]. J Clin Nephrol,2022,22(3):209-213.
[14] Schneider AG,Journois D,Rimmelé T.Complications of regional citrate anticoagulation:accumulation or overload[J]. Crit Care,2017,21(1):281.
[15] 卢亮,周娜,徐玉,等. 改良枸橼酸钠输注法在连续性血液净化患者中的应用[J]. 中华护理杂志,2020,55(12):1850-1854.
Lu L,Zhou N,Xu Y,et al.Application of modified citrate infusion method for patients under continuous renal replacement therapy[J]. Chin J Nurs,2020,55(12):1850-1854.
[16] 张东亮,张潘,张周沧. 分段枸橼酸抗凝进行含钙透析液高通量血液透析的临床观察[J]. 中国血液净化,2016,15(12):686-690.
Zhang DL,Zhang P,Zhang ZC.Observational study of segmented citrate anticoagulation in high flux hemodialysis with calcium-containing dialysate[J]. Chin J Blood Purif,2016,15(12):686-690.
