Faber L M, de Vries P M, Oe P L, van der Meulen J, Donker A J
Department of Internal Medicine, Free University Hospital, Amsterdam.
Neth J Med. 1990 Dec;37(5-6):219-24.
We describe our experience with sodium citrate as anticoagulant in the haemodialysis of 15 patients who were at high risk for bleeding. Furthermore, in six of these patients who were on prolonged citrate dialysis, the last month of heparin dialysis was compared with the first month in which citrate was used as anticoagulant. Our series confirms the suitability of citrate as anticoagulant in patients who are at high risk for bleeding. In the prolonged citrate dialysis group, however, there were complaints of paraesthesias. Probably, the citrate-induced metabolic alkalosis and the relatively low serum calcium concentration observed in these patients contributed to these complaints. To limit these side effects the acetate concentration in the dialysate needs to be reduced and, as magnesium also complexes with citrate, a calcium- and magnesium-free dialysate should be used to reduce the citrate infusion rate and thus the alkaline load in these patients. Furthermore, lowering the calcium infusion rate in order to lower the citrate infusion rate is not indicated because this induces low serum calcium concentration.
我们描述了在15例出血高危患者血液透析中使用柠檬酸钠作为抗凝剂的经验。此外，在其中6例接受长时间柠檬酸盐透析的患者中，将肝素透析的最后一个月与使用柠檬酸盐作为抗凝剂的第一个月进行了比较。我们的系列研究证实了柠檬酸盐作为出血高危患者抗凝剂的适用性。然而，在长时间柠檬酸盐透析组中，患者出现了感觉异常的主诉。可能是这些患者中观察到的柠檬酸盐诱导的代谢性碱中毒和相对较低的血清钙浓度导致了这些主诉。为了限制这些副作用，需要降低透析液中的醋酸盐浓度，并且由于镁也会与柠檬酸盐络合，应使用无钙和无镁的透析液来降低柠檬酸盐输注速率，从而降低这些患者的碱负荷。此外，不建议通过降低钙输注速率来降低柠檬酸盐输注速率，因为这会导致血清钙浓度降低。
