Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
Blood Purif. 2012;33(1-3):80-7. doi: 10.1159/000334641. Epub 2011 Dec 30.
There are limited data on systemic delivery of metabolic substrates during citrate anticoagulation. The direct citrate measurements are usually not available.
Patients on 2.2% acid-citrate-dextrose (ACD, n = 41) were compared to a control group on unfractionated heparin (n = 17). All were treated on 1.9-m(2) polysulfone filters. Samples were taken from the central venous catheter, ports pre- and post-filter and from effluent.
The gain of citrate in CVVH (n = 18) was not different from CVVHDF (n = 23, p = 0.8). Mean gain of citrate was 25.4 ± 6.4 mmol/h. The systemic loads of lactate (p = 0.12) and glucose (p = 0.23) in CVVH were similar to CVVHDF. Mean inputs of lactate and glucose were 62.9 ± 21.1 and 26.6 ± 10.4 mmol/h, respectively. The mean difference between post- and prefilter unmeasured anions (d-UA) correlated with mean difference of citrate concentrations (p < 0.0001, r(2) = 0.66). The estimated caloric load of the citrate modalities was 5,536 ± 1,385 kJ/ 24 h.
ACD might represent a significant load of metabolic substrates, particularly if used with lactate buffer. Systemic delivery of citrate can be predicted using d-UA in the extracorporeal circuit.
在柠檬酸抗凝期间，代谢底物的全身输送数据有限。通常无法直接测量柠檬酸。
将接受 2.2% 枸橼酸-葡萄糖酸（ACD，n = 41）治疗的患者与接受未分级肝素（n = 17）治疗的对照组进行比较。所有患者均在 1.9 m² 聚砜过滤器上接受治疗。从中心静脉导管、过滤器前后的端口以及流出物中采集样本。
CVVH（n = 18）和 CVVHDF（n = 23）中柠檬酸的净获得量无差异（p = 0.8）。柠檬酸的平均净获得量为 25.4 ± 6.4 mmol/h。CVVH 中乳酸（p = 0.12）和葡萄糖（p = 0.23）的全身负荷与 CVVHDF 相似。乳酸和葡萄糖的平均输入量分别为 62.9 ± 21.1 和 26.6 ± 10.4 mmol/h。过滤器前后未测量阴离子（d-UA）的平均差值与柠檬酸浓度的平均差值相关（p < 0.0001，r² = 0.66）。柠檬酸治疗模式的估计热量负荷为 5536 ± 1385 kJ/24 h。
ACD 可能代表代谢底物的重要负荷，如果与乳酸缓冲液一起使用则更是如此。可以使用体外回路中的 d-UA 预测柠檬酸的全身输送。
