中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (01): 31-34.doi: 10.3969/j.issn.1671-4091.2025.01.006

• 临床研究 • 上一篇    下一篇

含钙透析液和置换液的简化枸橼酸抗凝技术在连续性肾脏替代治疗中的前瞻性研究

强靖雅   唐 雪    王 芳   王蓓蓓    陈 芳    陈志文    张 凌   

  1. 610041 成都，1四川大学华西医院肾脏内科
  • 收稿日期:2024-05-13 修回日期:2024-09-12 出版日期:2025-01-12 发布日期:2025-01-12
  • 通讯作者: 张凌 E-mail:zhanglinglzy@163.com
  • 基金资助:

Prospective study of calcium-containing dialysate and replacement fluid with simplified citrate anticoagulation technique in continuous renal replacement treatment

QIANG Jing-ya, TANG Xue, WANG Fang, WANG Bei-bei, CHEN Fang, CHEN Zhi-wen, ZHANG Ling   

  1. 1Department of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China
  • Received:2024-05-13 Revised:2024-09-12 Online:2025-01-12 Published:2025-01-12
  • Contact: 610041 成都，1四川大学华西医院肾脏内科 E-mail:zhanglinglzy@163.com

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摘要： 目的 观察使用含钙透析液和置换液的局部枸橼酸抗凝(regional citrate anticoagulation，RCA)技术在连续性肾脏替代治疗(continuous renal replacement treatment，CRRT)中的安全性及有效性。 方法 前瞻性收集2020年1月—2021年12月在四川大学华西医院行CRRT的患者，采用枸橼酸抗凝方案的连续性静脉-静脉血液透析滤过(continuous veno-venous haemodiafiltration,CVVHDF)模式。血管通路采用颈内/股静脉留置双腔导管，起始血流量为150 ml/min，含钙透析液和置换液速度均为1000 ml/h，4%枸橼酸钠溶液以180 ml/h的起始速度泵入。治疗过程中分别在0 、6、12、24、48小时测定滤前及滤后游离钙水平，收集体外循环管路寿命、治疗参数以及并发症等。 结果 共纳入28例患者，44例次体外循环管路，42例次按计划CRRT，平均体外循环管路寿命为(44.0±24.6)h，体外循环管路寿命＜24小时共11例(26.2%)，24小时≤体外循环管路寿命＜48小时共13例(31.0%)，48小时≤体外循环管路寿命≤72小时共18例(42.9%)。治疗6小时(t=0.612，P=0.969)、12小时(t=0.456，P=0.625)、24小时(t=0.848，P=0.298)、48小时(t=0.411，P=0.415)滤前钙离子水平与基线(0小时)外周血游离钙离子比较均无统计学差异。治疗6小时(t=0.294，P=0.774)、12小时   (t=0.246，P=0.405)、24小时(t=0.191，P=0.853)、48小时(t=0.059，P=0.955)滤后钙离子水平与基线(0小时)滤后钙离子比较均无统计学差异。1例次(2.3%)患者出现代谢性碱中毒，1例次(2.3%)出现枸橼酸蓄积。 结论 采用含钙透析液和置换液的RCA技术在CRRT中是安全且有效的，适用于含一体化枸橼酸抗凝系统的CRRT设备，值得临床进一步推广应用。

关键词: 含钙置换液, 枸橼酸抗凝, 连续性肾脏替代治疗

Abstract: Objective To observe the effectiveness and safety of calcium-containing dialysate and replacement fluid with regional citrate anticoagulation in continuous renal replacement treatment (CRRT).  Methods  We prospectively recruited the patients treated with CRRT in West China Hospital of Sichuan University during January 2020 to December 2021. They were treated with the model of continuous veno-venous hemodiafiltration (CVVHDF) using citrate anticoagulation method. Blood access used the cuffed catheter in internal jugular vein or femoral vein. The initial blood flow was 150 ml/min, the rate of calcium-containing dialysate and replacement fluid was 1,000 ml/h, and 4% sodium citrate solution was pumped at the initial rate of 180 ml/h. Calcium ion was measured before and after the filtration at 0h, 6h, 12h, 24h and 48h. Lifespan of the extracorporeal circulation pipeline, treatment parameters and complications were collected. Results  A total of 28 patients were enrolled in this study, including 44 times of extracorporeal circulation pipeline and 42 times of scheduled CRRT. The average lifespan of the extracorporeal circulation pipeline was 44.0±24.6h, including the lifespan of <24h in 11 cases (26.2%), 24h ～ ＜48h in 13 cases (31.0%), and 48h ～≤72h in 18 cases (42.9%). There were no significant differences in the levels of calcium ion before filtration at 6h (t=0.612, P=0.969), 12h (t=0.456, P=0.625), 24h (t=0.848, P=0.298) and 48h (t=0.411, P=0.415), as compared with the baseline level at 0h. There were also no significant differences in the levels of calcium ion after filtration at 6h (t=0.294, P=0.774), 12h (t=0.246, P=0.405), 24h (t=0.191, P=0.853) and 48h (t=0.059, P=0.955), as compared with the level at 0h. Metabolic alkalosis was found in one patient (2.3%), and citric acid accumulation was found in one patient (2.3%).  Conclusion  The calcium-containing dialysate and replacement fluid with regional citrate anticoagulation for CRRT is effective and safe, and is suitable for the use of CRRT equipment with integrated citrate anticoagulation system. This method is worthy of further clinical application.

Key words: Calcium-containing replacement fluid, Citrate anticoagulant, Continuous renal replacement therapy

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