Tuerdi B, Zuo L, Sun H, Wang K, Wang Z, Li G
Respiratory Intensive Care Units, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Intensive Care Units, Branch of the First Affiliated Hospital of Xinjiang Medical University, Changji, Xinjiang, China.
Braz J Med Biol Res. 2017 Nov 17;51(1):e6378. doi: 10.1590/1414-431X20176378.
The aim of this study was to discuss the safety and efficacy of regional citrate anticoagulation (RCA) on continuous blood purification (CBP) during the treatment of multiple organ dysfunction syndrome (MODS). Thirty-five patients with MODS were divided into two groups: the local citrate anticoagulation (RCA) group, and the heparin-free blood purification (hfBP) group. The MODS severity was assessed according to Marshall's MODS score criteria. Blood coagulation indicators, blood pressure, filter lifespan, filter replacement frequency, anticoagulation indicators, and main metabolic and electrolyte indicators were analyzed and compared between RCA and hfBP groups. RCA resulted in lower blood pressure than hfBP. The filter efficacy in RCA treatment was longer than in the hfBP group. The blood clearance of creatine, blood urea nitrogen and uric acid was better in the RCA group. RCA also led to higher pH than hfBP. Neither treatment resulted in severe bleeding events. In addition, MODS score was positively correlated with prothrombin time and activated partial thromboplastin time but negatively correlated with platelet concentration. RCA is a safer and more effective method in CBP treatment; however, it could also lead to low blood pressure and blood alkalosis.
本研究旨在探讨局部枸橼酸抗凝（RCA）在多器官功能障碍综合征（MODS）治疗中用于连续性血液净化（CBP）的安全性和有效性。35例MODS患者被分为两组：局部枸橼酸抗凝（RCA）组和无肝素血液净化（hfBP）组。根据马歇尔MODS评分标准评估MODS严重程度。分析并比较RCA组和hfBP组之间的凝血指标、血压、滤器使用寿命、滤器更换频率、抗凝指标以及主要代谢和电解质指标。RCA组的血压低于hfBP组。RCA治疗的滤器效能比hfBP组长。RCA组中肌酐、血尿素氮和尿酸的血液清除率更好。RCA组的pH值也高于hfBP组。两种治疗均未导致严重出血事件。此外，MODS评分与凝血酶原时间和活化部分凝血活酶时间呈正相关，但与血小板浓度呈负相关。RCA在CBP治疗中是一种更安全、更有效的方法；然而，它也可能导致低血压和血液碱中毒。
