Intensive Care Unit, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Children Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Intensive Care Unit, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Children Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China,
Blood Purif. 2020;49(4):394-399. doi: 10.1159/000504562. Epub 2020 Feb 4.
BACKGROUND/AIMS: Continuous renal replacement therapy (CRRT) has been used widely in the treatment of critically ill children for its continuity. However, sometimes we have to interrupt the continuity for necessary surgeries or blood transfusions. Our objective was to demonstrate a feasible self-circulation anticoagulation protocol based on citrate (CSAP) to address discontinuity during CRRT.
We conducted a prospective observational study of 57 pediatric patients undergoing 88 CRRT sessions that were receiving CSAP during the treatment discontinuity period by using an anticoagulation regimen containing 5 mL 4% sodium citrate in 50 mL of saline to maintain the continuity. We documented the reasons for CSAP and the total duration of the treatment. We assessed the in-line pressure recordings, blood routine examination, blood electrolytes, and blood gas analysis before, throughout, and after the period of CSAP.
The average duration of CSAP was 118.5 ± 45.3 min. There was no significant increase in arterial pressures, venous pressures, and transmembrane pressures and no significant decreases in blood cell counts observed at the end of the CSAP, compared to the data recorded at the beginning of the CSAP. Compared to before the CSAP, there was no significant change in the ratio of total to ionized calcium, Na+, HCO3-, and pH value after CSAP.
CSAP might be a safe, effective, and easy approach for use during the treatment discontinuity of CRRT in children.
背景/目的：连续肾脏替代疗法（CRRT）因其连续性而广泛应用于危重症儿童的治疗。然而，有时我们不得不为了必要的手术或输血而中断连续性。我们的目标是展示一种基于柠檬酸盐（CSAP）的可行的自循环抗凝方案，以解决 CRRT 中断期间的不连续性问题。
我们进行了一项前瞻性观察研究，共纳入 57 例接受 CRRT 治疗的儿科患者，共进行了 88 次 CRRT 治疗，在治疗中断期间使用含有 5 毫升 4%柠檬酸钠的 50 毫升生理盐水的抗凝方案来维持连续性。我们记录了 CSAP 的原因和治疗的总持续时间。我们评估了 CSAP 前后的在线压力记录、血常规检查、电解质和血气分析。
CSAP 的平均持续时间为 118.5 ± 45.3 分钟。与 CSAP 开始时相比，CSAP 结束时动脉压、静脉压和跨膜压没有明显升高，血细胞计数也没有明显下降。与 CSAP 前相比，CSAP 后总钙与离子钙的比值、Na+、HCO3-和 pH 值没有明显变化。
CSAP 可能是儿童 CRRT 治疗中断期间一种安全、有效、简便的方法。
