中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (08): 576-579.doi: 10.3969/j.issn.1671-4091.2022.08.008

• 临床研究 • 上一篇    下一篇

含钙透析液和置换液局部枸橼酸抗凝连续静脉静脉血液透析滤过临床观察

席春生     刘同存     蔡蕊莲     张 萌    方春天    刘 飞     魏育深    王谨涵涵   

  1. 730050 兰州，中国人民解放军联勤保障部队第九四〇医院 1肾脏病科 2血液净化中心
  • 收稿日期:2022-01-20 修回日期:2022-06-02 出版日期:2022-08-12 发布日期:2022-08-12
  • 通讯作者: 席春生 E-mail:chunshxi@sina.com

Clinical investigation of regional citrate anticoagulation continuous venovenous hemodiafiltration with calcium-containing dialysate and replacement solution 

XI Chun-sheng, LIU Tong-cun, CAI Rui-lian, ZHANG Meng, FANG Chun-tian, LIU Fei, WEI Yu-shen, WANG Jin-han   

  1. Department of Nephrology, 2Center of Blood Purification, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, China
  • Received:2022-01-20 Revised:2022-06-02 Online:2022-08-12 Published:2022-08-12
  • Contact: XI Chun-sheng E-mail:chunshxi@sina.com

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摘要： 目的  观察含钙透析液和置换液局部枸橼酸抗凝(regional citrate anticoagulation, RCA)连续静脉静脉血液透析滤过(continuous venovenous hemodiafiltration,CVVHDF)的可行性和安全性。 方法  回顾性评估2021年7月～2021年12月在联勤保障部队第九四〇医院行含钙透析液和置换液RCA-CVVHDF资料完整的患者。从电子病历收集评估RCA-CVVHDF治疗参数、滤器寿命和新发代谢性并发症等情况。 结果  共分析评估了56例患者，139套滤器，213连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)天。其中，男43例，占76.5%，女13例，占23.5%；年龄18～99岁，平均年龄(59.6±20.8)岁；滤器寿命(6～72)h,平均(35±23)h；滤器寿命≤24h占37.4%，25～48h占34.5%，49～72h占17.3%，≥72h占10.8%。轻中度低钙血症和低钠血症分别为18.0和5.0次/100 CRRT天，未发生重度低钙血症、低钠血症和任何类型的高钙血症、高钠血症；枸橼酸蓄积2.0/100 CRRT天，代谢性酸中毒8.0/100 CRRT天。 结论  含钙透析液和置换液行RCA-CVVHDF是可行的，并且定期监测和及时调整下，也是安全的，值得进一步推广应用。

关键词: 局部枸橼酸抗凝, 连续性肾脏替代治疗, 血液滤过基础置换液

Abstract: Objective  To investigate and evaluate the efficacy and safety of regional citrate anticoagulation continuous venovenous hemodiafiltration (RCA-CVVHDF) with calcium-containing dialysate and replacement solution.  Methods  The efficacy and safety of RCA-CVVHDF with calcium-containing dialysate and replacement solution performed in The 940th Hospital of Joint Logistics Support Force of Chinese PLA between Jul 1, 2021 and December 31, 2021 were retrospectively studied. Their CVVHDF operational characteristics, circuit outcomes and new-onset metabolic complications after RCA-CVVHDF with calcium-containing dialysate and replacement solution were analyzed.  Results   A total of 56 patients, 139 filters and 213 days of CRRT were analyzed. In the 56 patients, 43 were males (76.5%) and 13 were females (23.5%), with the average age of 59.6±20.8 years old (18-99 years old) The median filter life was 35±23h (6～72h), and filter life ≤24h, 25～48h, 49～72h and ≥72h were found in 37.4%, 34.5%, 17.3% and 10.8% respectively of the filters. Mild-to-moderate hypocalcemia and hyponatremia were observed in 18.0 and 5.0 per 100 CRRT days, respectively, but severe hypocalcemia, hyponatremia and any types of hypercalcemia and hypernatremia were not observed. Citrate accumulation was observed in 2.0 per 100 CRRT days, and metabolic acidosis occurred in 8.0 per 100 CRRT days. Conclusions   Under close monitoring, RCA-CVVHDF with calcium-containing dialysate and replacement solution can be effective and safe. This method is worth for further clinical practice.

Key words: Regional citrate anticoagulation, Continuous renal replace therapy, Hemofiltration basic replacement solution

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