目的 探讨分段式枸橼酸抗凝对连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)非计划下机的影响，为临床CRRT质量管理提供参考依据。 方法 回顾性选取2025年1月─9月在河北大学附属医院重症医学科行CRRT的80例患者，分为分段式抗凝组与非分段式抗凝组，收集患者的一般资料、治疗时间、非计划下机率、透析时静脉壶凝血情况、滤器跨膜压、回输压、实验室检查结果及平均治疗费用等指标，比较2组指标差异。 结果 分段式抗凝组非计划下机发生率(χ²=9.928，P=0.002)、静脉壶凝血发生率(χ²=12.679，P=0.002)、平均治疗费用(t=-5.498，P＜0.001)均低于非分段式抗凝组，平均治疗时间长于非分段式抗凝组(t=7.576，P＜0.001)。治疗过程中分段式抗凝组患者血滤器后游离钙在治疗第6 h略高于非分段式抗凝组(t=2.793，P=0.007)，但该差异处于临床安全范围；治疗结束时，2组间外周游离钙(t=-0.769，P=0.444)、滤后游离钙(t=-0.358，P=0.721)、pH值(t=1.030，P=0.306)及碳酸氢根离子(t=-0.883，P=0.380)比较均无显著差异。 结论 分段式抗凝可以有效降低CRRT非计划下机发生率，提高CRRT治疗效率，并减轻患者经济负担。

Objective To explore the effect of segmental citrate anticoagulation on unplanned discontinuation of continuous renal replacement therapy (CRRT), and to provide a reference for clinical CRRT quality management. Methods  Eighty CRRT patients in the intensive care unit of Affiliated Hospital of Hebei University from January to September 2025 were retrospectively selected and divided into a segmental anticoagulation group and a non-segmental anticoagulation group. Indicators including general data, treatment duration, unplanned discontinuation rate, venous chamber coagulation, transmembrane pressure, return pressure, laboratory test results, and average treatment cost were collected, and the differences in these indicators between the two groups were compared. Results  The incidence of unplanned discontinuation (χ²=9.928, P=0.002), the incidence of venous chamber coagulation (χ²=12.679, P=0.002), and the average treatment cost (t=-5.498, P＜0.001) in the segmental anticoagulation group were all lower than those in the non-segmental anticoagulation group, while the average treatment duration (t=7.576, P＜0.001) was longer. There were no significant overall differences in internal environment indicators between the two groups during treatment, except that the post-filtration ionized calcium in the segmental anticoagulation group was slightly higher than that in the non-segmental anticoagulation group at the 6th hour of treatment (t=2.793, P=0.007), but this difference was within the clinical safety range. At the end of treatment, no significant differences were observed between the two groups in peripheral ionized calcium (t=-0.769, P=0.444), post-filtration ionized calcium (t=-0.358, P=0.721), pH value (t=1.030, P=0.306), or bicarbonate ion (t=-0.883, P=0.380). Conclusion  Segmental citrate anticoagulation can effectively reduce the incidence of CRRT unplanned discontinuation, improve the efficiency of CRRT treatment, and reduce the economic burden on patients.