Monchi Mehran
Intensive care deparment, Centre Hospitalier de Melun, Melun, F-77000, France.
Transfus Apher Sci. 2017 Feb;56(1):28-30. doi: 10.1016/j.transci.2016.12.013. Epub 2016 Dec 30.
By chelating ionized calcium, citrate allows extracorporeal circuit anticoagulation without a bleeding risk for the patient. Citrate anticoagulation is also associated with a reduced activation of leucocytes and platelets. Citrate clearance by citric acid cycle (Krebs cycle) is not modified by renal failure, but is reduced by about 50% in patients with cirrhosis. Toxic effects of citrate result from a decrease in plasma ionized calcium of the patient. The first side effect is a prolongation of the QT interval. Clinical signs of hypocalcemia and hypotension in humans appear below 0.9mmol/L of plasma ionized calcium.
通过螯合离子钙，枸橼酸盐可实现体外循环抗凝，且不会给患者带来出血风险。枸橼酸盐抗凝还与白细胞和血小板的活化减少有关。通过柠檬酸循环（克雷布斯循环）进行的枸橼酸盐清除不受肾衰竭影响，但在肝硬化患者中会降低约50%。枸橼酸盐的毒性作用源于患者血浆离子钙的降低。第一个副作用是QT间期延长。人体血浆离子钙低于0.9mmol/L时会出现低钙血症和低血压的临床症状。
