用于连续性肾脏替代治疗的离子化镁和局部枸橼酸盐抗凝

Ionized Magnesium and Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy.

作者信息

Zakharchenko Mychajlo, Leden Pavel, Rulíšek Jan, Los Ferdinand, Brodska Helena, Balik Martin

机构信息

Department of Anesthesiology and Intensive Care, Charles University and General University Hospital in Prague, Prague, Czech Republic.

出版信息

Blood Purif. 2016;41(1-3):41-7. doi: 10.1159/000440972. Epub 2015 Oct 20.

DOI:10.1159/000440972

PMID:26960213

Abstract

BACKGROUND

The regional citrate anticoagulation (RCA) induces changes in total (Catot) and ionized (Ca2+) calcium. As of now, we do not have much information about parallel changes of total (Mgtot) and ionized (Mg2+) magnesium.

METHODS

The authors compared changes of Mg2+ and Mgtot with changes of Ca2+ and Catot in 32 critically ill patients on 4% trisodium citrate (4% TSC) with calcium-free fluids.

RESULTS

The median continuous venovenous hemodiafiltration balance of Mgtot was -0.91 (-1.18 to -0.53) mmol/h compared to the median balance of Catot 0.86 (0.08-1.55) mmol/h. Postfilter Mg2+ decreased by 68.3% (70.8-65.6) in parallel (r = 0.41, p = 0.03) to decrease of postfilter Ca2+ (by 70.2% (73.0-66.1)) and was significantly related to the postfilter Ca2+ (r = 0.50, p < 0.001). The decrease of prefilter to postfilter Ca2+ correlated to a dosage of 4% TSC per blood flow (r = 0.37, p = 0.04).

CONCLUSIONS

The loss of Mgtot during RCA is not covered by magnesium concentration in ordinary dialysis/substitution fluid and may lead to the depletion of total body magnesium. The postfilter Mg2+ is significantly related to the postfilter Ca2+. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi = 440972.

摘要

背景

局部枸橼酸抗凝（RCA）会引起总钙（Catot）和离子钙（Ca2+）的变化。目前，我们对总镁（Mgtot）和离子镁（Mg2+）的平行变化了解不多。

方法

作者比较了32例危重症患者在使用无钙液体的4%枸橼酸钠（4% TSC）进行区域枸橼酸抗凝时，Mg2+和Mgtot的变化与Ca2+和Catot变化的情况。

结果

Mgtot的连续静静脉血液透析滤过平衡中位数为-0.91（-1.18至-0.53）mmol/h，而Catot的平衡中位数为0.86（0.08 - 1.55）mmol/h。滤器后Mg2+下降了68.3%（70.8 - 65.6），与滤器后Ca2+下降（70.2%（73.0 - 66.1））平行（r = 0.41，p = 0.03），且与滤器后Ca2+显著相关（r = 0.50，p < 0.001）。滤器前至滤器后Ca2+的下降与每血流4% TSC的剂量相关（r = 0.37，p = 0.04）。