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Title: [Application of improved regional citrate anticoagulation in continuous hemofiltration in children].
Author: Bai K, Liu CJ, Fu YQ, Xu F.
Journal: Zhonghua Er Ke Za Zhi; 2017 May 04; 55(5):334-337. PubMed ID: 28482382.
Abstract:
Objective: To investigate the application of regional citrate anticoagulation with calcium hemofiltration basic solution in continuous hemofiltration in children. Method: The clinical data of 18 patients with citrate anticoagulation in continuous hemofiltration in children, excluding the hepatic failure and septic shock cases, were analyzed retrospectively, from September 2015 to August 2016 in Intensive Care Unit of the Children's Hospital of Chongqing Medical University.The commercial calcium hemofiltration basic solution was used as displacement liquid . The blood gas analysis, electrolyte, four coagulation tests during the treatment and the corresponding relations of quantity of blood flow(QB), quantity of citrate flow(QCi), quantity of sodium bicarbonate flow(QSB), quantity of calcium flow(QCa), quantity of filtered solution flow (Qf) were monitored. Meanwhile, the blood gas analysis, electrolyte, four coagulation tests, useful life of filter, bleeding and clotting events internal and external before, during and after the treatments were monitored, too. And the common complications of citrate anticoagulation, such as hypocalcaemia, metabolic alkalosis, citrate accumulation and hypernatremia were observed. Result: Continuous hemofiltration was applied in 18 patients for 734.5 hours, and the average useful life of filter was (25±11)h.There was no obvious clotting event. There were 168 groups of datum of the blood gas analysis, electrolyte, four coagulation tests during the treatment and the relationships of QB, QCi, QSB, QCa, Qf had been collected. The relationships of the initial parameter settings of QB, QCi, QSB, QCa and Qf were concluded as QCi=1.8×QB, QCa=0.12×QB, QSB=0.01×Qf . There were 150 times(89.3%)of extracorporeal ionized calcium(iCa(E)(2+)) and 162 times(96.4%) of intracorporal ionized calcium(iCa(I)(2+)) reached the anticoagulation target. Although all the comparisons of Na(+) ((136.2±4.1)vs.(138.2±2.4)vs.(138.5±3.9)mmol/L), iCa(2+) ((1.07±0.11)vs.(1.21±0.12)vs.(1.17±0.09)mmol/L), HCO(3)(-) ((22±4)vs.(28±5)vs. (26±4)mmol/L) among before, during and after treatment had significant difference(F=6.414, 18.950, 19.151; P=0.002, 0.000, 0.000). Each mean parameter was within the nearly normal range, except that the HCO(3)(-) increased slightly. High HCO(3)(-) was the most common complications, which happened 87 times (51.8%) during the treatment and 11 cases(37.9%) after the treatment. There was none with refractory hypocalcemia and total ionized calcium(TCa(2+) )/iCa(2+) above 2.5, which hints the accumulation of citrate. Conclusion: The commercialized displacement liquid containing calcium can be used in RCA-CHF in children safely and simply. 目的： 探讨含钙血液滤过置换基础液在儿童局部枸橼酸抗凝(RCA)－连续性血液滤过(CHF)中的应用。 方法： 回顾性病例总结，分析2015年9月至2016年8月重庆儿童医院重症监护室行RCA－CHF共18例患儿(排除肝功能衰竭及脓毒性休克病例)的血液净化参数、疗效及并发症等相关资料。置换液采用商品化含钙血液滤过置换基础液，监测治疗中体内、外血气分析、电解质、凝血四项及对应的血泵流速(QB)、4%枸橼酸钠速度(QCi)、5%碳酸氢钠速度(QSB)、10%葡萄糖酸钙速度(QCa)、置换液速度(Qf)关系；比较治疗前、后血气分析、电解质、凝血四项、滤器使用时间与出凝血情况；观察枸橼酸抗凝常见并发症：低钙血症、代谢性酸或碱中毒、枸橼酸蓄积、高钠血症等发生情况。治疗前、中、后比较采用单因素方差分析。 结果： 18例患儿共行29次RCA－CHF治疗，共734.5 h，平均(25±11)h，最长一次63 h，无一例出现体外循环管路及滤柱Ⅱ级以上凝血。共收集治疗中体内、外血气分析、电解质及对应的QB、QCi、QSB、QCa、Qf数据168组，凝血四项38次及治疗前、后血气分析、电解质及凝血四项29组。推算出QB、QCi、QSB、QCa、Qf的量效关系，即QCi＝1.8×QB，QCa＝0.12×QB，QSB＝0.01×Qf。治疗中体外循环离子钙(iCa(E)(2＋))、体内离子钙(iCa(I)(2＋))达抗凝目标分别为150次(89.3%)、162次(96.4%)。治疗前、中、后Na(＋)[(136.2±4.1)、(138.2±2.4)、(138.5±3.9)mmol/L]，离子钙(iCa(2＋)) [(1.07±0.11)、(1.21±0.12)、(1.17±0.09)mmol/L]，HCO(3)(-) [(22±4)、(28±5)、(26±4)mmol/L]，差异均有统计学意义(F＝6.414、18.950、19.151，P＝0.002、0.000、0.000);但除治疗中HCO(3)(-)稍增高外，其余均值均在正常范围。治疗中及治疗后以HCO(3)(-)增高并发症多见，治疗中达87次(51.8%)，治疗后11例(37.9%)；无顽固低iCa(2＋)及总钙(TCa(2＋))/ iCa(2＋)>2.5等枸橼酸蓄积病例。 结论： 商品化含钙基础置换液可以相对简单、安全地用于儿童RCA－CHF治疗。.

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