Egi M, Naka T, Bellomo R, Langenberg C C, Li W, Fealy N, Baldwin I
Department of Intensive Care, University of Melbourne, Austin Hospital, Austin Health, Melbourne, Australia.
Int J Artif Organs. 2008 Mar;31(3):228-36. doi: 10.1177/039139880803100306.
To compare the acid-base balance effects of two different citrate doses for regional citrate anticoagulant (RCA) for continuous veno-venous hemofiltration (CVVH).
We used a commercial citrate fluid (citrate concentration: 11 mmol/L) from July 2003 to July 2004 (period A) in 22 patients; then changed to a new citrate fluid (citrate concentration: 14 mmol/L) from July 2004 to Feb 2005 (Period B) in 21 patients. Replacement fluid rate was fixed at 2,000 ml/h. We measured all relevant variables for acid-base analysis according to the Stewart-Figge methodology.
After commencement of RCA-CVVH, there was a change in bicarbonate and base excess (BE) toward acidosis for both fluids. This change was significantly different between period A and B at 6 and 12 hours (pH: p<0.01, BE: p<0.05) with greater decreases with the 11 mmol/L citrate fluid. These changes were mostly secondary to an increase in the strong ion difference (SID) and occurred despite an increased strong ion gap (SIG) (+0.5 mEq/L vs. +1.5 mEq/L; p<0.01) in the higher citrate concentration fluid. Cessation of RCA-CVVH was associated with short-lived differences in bicarbonate and SIG which were similar to those seen on initiation of RCA-CVVH but in the opposite direction.
A small increase This was partly offset by an increase in SIG, consistent with increased citratemia. Cessation of treatment showed a differential improvement in SIG also consistent with disposal of therapy-associated citrate. These observations might assist clinicians in interpreting acidbase changes during RCA-CVVH.in citrate infusion rate caused an alkalinizing increase in SID.
比较两种不同剂量柠檬酸盐用于连续性静脉-静脉血液滤过（CVVH）区域枸橼酸盐抗凝（RCA）时对酸碱平衡的影响。
2003年7月至2004年7月（A期），我们对22例患者使用了一种市售枸橼酸盐溶液（枸橼酸盐浓度：11 mmol/L）；然后在2004年7月至2005年2月（B期），对21例患者换用了一种新的枸橼酸盐溶液（枸橼酸盐浓度：14 mmol/L）。置换液速率固定为2000 ml/h。我们根据Stewart-Figge方法测量了所有用于酸碱分析的相关变量。
RCA-CVVH开始后，两种溶液的碳酸氢盐和碱剩余（BE）均向酸中毒方向变化。在6小时和12小时时，A期和B期之间的这种变化有显著差异（pH：p<0.01，BE：p<0.05），11 mmol/L枸橼酸盐溶液的下降幅度更大。这些变化主要继发于强离子差（SID）增加，尽管较高枸橼酸盐浓度溶液中的强离子隙（SIG）增加（+0.5 mEq/L对+1.5 mEq/L；p<0.01），但仍发生了这些变化。RCA-CVVH停止与碳酸氢盐和SIG的短暂差异有关，这些差异与RCA-CVVH开始时所见相似，但方向相反。
枸橼酸盐输注速率的小幅增加导致SID出现碱化性增加。这部分被SIG的增加所抵消，这与枸橼酸血症增加一致。停止治疗显示SIG有差异改善，这也与治疗相关枸橼酸盐的清除一致。这些观察结果可能有助于临床医生解释RCA-CVVH期间的酸碱变化。
