接受血浆滤过吸附治疗的危重症患者的局部枸橼酸抗凝
Regional citrate anticoagulation in critically ill patients treated with plasma filtration and adsorption.
作者信息
Mariano Filippo, Tetta Ciro, Stella Maurizio, Biolino Piera, Miletto Antonio, Triolo Giorgio
机构信息
Department of Medical Area, Nephrology and Dialysis Unit, CTO Hospital, Turin, Italy.
出版信息
Blood Purif. 2004;22(3):313-9. doi: 10.1159/000078788.
BACKGROUND
In high-risk bleeding conditions conventional systemic anticoagulation with heparin is a contraindication to renal replacement therapy. We evaluate the feasibility and safety of regional citrate anticoagulation in high-risk bleeding conditions during coupled plasma filtration adsorption (CPFA).
METHODS
Thirteen critically ill patients (9 severely burned, 4 polytraumas) with septic shock and acute renal failure treated with CPFA-CVVHD by using bicarbonate-based solutions (heparin-CPFA group, 58 sessions) or with CPFA-CVVHF using citrate (citrate-CPFA group, 36 sessions).
RESULTS
Plasma flow and used cartridges showed no differences between the citrate-CPFA and heparin-CPFA groups, while lost clotted cartridges were significantly lower in the citrate-CPFA group. Blood ionized calcium (iCa2+), Ca2+ infusion, pH and bicarbonates remained constant during citrate-CPFA, with no difference between pre- and post-cartridge plasma citrate. A significant positive correlation between iCa2+ in blood and ultrafiltrate was present.
CONCLUSIONS
These suits demonstrate the feasibility and safety of regional citrate anticoagulation in severely burned and polytrauma septic patients treated by CPFA.
背景
在高出血风险情况下，使用肝素进行传统的全身抗凝是肾脏替代治疗的禁忌证。我们评估了在配对血浆滤过吸附（CPFA）期间，高出血风险情况下局部枸橼酸盐抗凝的可行性和安全性。
方法
13例患有脓毒症休克和急性肾衰竭的重症患者（9例严重烧伤，4例多发伤），使用基于碳酸氢盐的溶液通过CPFA - CVVHD进行治疗（肝素 - CPFA组，58次治疗），或使用枸橼酸盐通过CPFA - CVVHF进行治疗（枸橼酸盐 - CPFA组，36次治疗）。
结果
枸橼酸盐 - CPFA组和肝素 - CPFA组之间的血浆流量和使用的滤器无差异，而枸橼酸盐 - CPFA组中堵塞的滤器明显更少。在枸橼酸盐 - CPFA期间，血离子钙（iCa2 +）、钙输注、pH值和碳酸氢盐保持恒定，滤器前后血浆枸橼酸盐无差异。血中iCa2 +与超滤液之间存在显著正相关。
结论
这些结果证明了在接受CPFA治疗的严重烧伤和多发伤脓毒症患者中，局部枸橼酸盐抗凝的可行性和安全性。
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