Liet Jean-Michel, Allain-Launay Emma, Gaillard-LeRoux Bénédicte, Barrière François, Chenouard Alexis, Dejode Jean-Marc, Joram Nicolas
Unité de Réanimation Pédiatrique, Pôle Femme-Enfant-Adolescent, Centre hospitalier universitaire (CHU) de Nantes, 38 Boulevard Jean-Monnet, 44093, Nantes, France,
Pediatr Nephrol. 2014 Sep;29(9):1625-31. doi: 10.1007/s00467-014-2770-2. Epub 2014 Feb 15.
In continuous renal replacement therapy (CRRT), regional citrate anticoagulation offers an attractive alternative to heparinization, especially for children with a high bleeding risk.
We report on a new management approach to CRRT using integrated citrate software and physiological sodium concentration solutions. Convective filtration was performed with pre-filter citrate anticoagulation using an 18 mmol/L citrate solution and a post-filter replacement fluid. The citrate flow rate was automatically adjusted to the blood flow rate by means of integrated citrate software. Similarly, calcium was automatically infused into children to maintain their blood calcium levels within normal range.
Eleven CRRT sessions were performed (330 h) in seven critically ill children aged 3-15 years (extreme values 15-66 kg). Disease categories included sepsis with multiorgan dysfunction (n = 2) and hemolytic uremic syndrome (n = 5). Median effluent dose was 2.1 (extreme values 1.7-3.3) L/h/1.73 m2. No session had to be stopped because of metabolic complications. Calcium levels, both in the circuits and in the circulating blood of the children, remained stable and secure.
Regional citrate anticoagulation can be used in children with a body weight of >15 kg using integrated citrate software and commercially available solutions with physiological sodium concentrations in a safe, effective and convenient procedure.
在连续性肾脏替代治疗（CRRT）中，局部枸橼酸盐抗凝是肝素抗凝的一种有吸引力的替代方法，尤其适用于出血风险高的儿童。
我们报告一种使用集成枸橼酸盐软件和生理钠浓度溶液的CRRT新管理方法。采用18 mmol/L枸橼酸盐溶液进行滤器前枸橼酸盐抗凝及滤器后置换液进行对流过滤。通过集成枸橼酸盐软件将枸橼酸盐流速自动调整至血流速度。同样，自动给儿童输注钙剂以维持其血钙水平在正常范围内。
对7例3 - 15岁危重症儿童进行了11次CRRT治疗（共330小时）（体重极值为15 - 66 kg）。疾病类型包括伴有多器官功能障碍的脓毒症（n = 2）和溶血尿毒综合征（n = 5）。中位超滤剂量为2.1（极值为1.7 - 3.3）L/h/1.73 m²。没有因代谢并发症而停止治疗的情况。回路及儿童循环血液中的钙水平均保持稳定和安全。
使用集成枸橼酸盐软件和具有生理钠浓度的市售溶液，局部枸橼酸盐抗凝可安全、有效且方便地用于体重>15 kg的儿童。
