Perdrix J P, Lepape A, Gronlier T, Grozel J M, Banssillon V
Département d'Anesthésie-Réanimation, Centre Hospitalier Lyon-Sud, Pierre-Bénite.
Ann Fr Anesth Reanim. 1988;7(1):31-5. doi: 10.1016/s0750-7658(88)80009-1.
During haemodialysis in the patient at high risk for bleeding, heparin cannot be safely used to prevent clotting in the dialysis assembly. Among numerous procedures proposed to reduce the risk for bleeding, Pinnick et al. (N Engl J Med, 308: 258, 1983) proposed the use of citrate as the sole anticoagulant. Citrate toxicity and efficiency were studied during 44 haemodialyses carried out in thirteen patients with a high risk for bleeding or with active bleeding. Three patients had hepatic failure. Two types of citrate solution were used, the trisodium form of citrate (102 mmol.l-1 citrate) or the monosodium form (306 mmol.l-1 citrate). The solutions were infused with a calibrated, pressure insensitive pump, before the dialysis unit at a flow rate of 600 ml.h-1 and 200 ml.h-1 respectively. Sufficient citrate was infused to maintain a clotting time of the blood line and dialyser of more than 18 min. Standard 10% calcium chloride was infused at a constant rate of 7 mg.min-1 into the blood being returned to the patient. The patients were dialysed for 4 h for each haemodialysis with a single-pass system. The dialyses were uncomplicated; no active bleeding was noted. The patient's clotting time was significantly reduced during haemodialysis (18.1 +/- 8.9 min to 14.5 +/- 6.3 min; p less than 0.001). Two-hundred and twenty serum citrate levels were measured. Only nine were above the toxic value of 2 mmol.l-1. No clinical evidence of a decrease in ionized calcium was found: there was no change in the corrected QT intervals and blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
对于有出血高风险的患者，在血液透析过程中，无法安全使用肝素预防透析装置内凝血。在众多为降低出血风险而提出的方法中，平尼克等人（《新英格兰医学杂志》，308: 258, 1983）提议使用柠檬酸盐作为唯一的抗凝剂。在13例有出血高风险或有活动性出血的患者进行的44次血液透析过程中，对柠檬酸盐的毒性和有效性进行了研究。3例患者有肝功能衰竭。使用了两种柠檬酸盐溶液，柠檬酸钠形式（102 mmol·l⁻¹柠檬酸盐）或柠檬酸钠形式（306 mmol·l⁻¹柠檬酸盐）。这些溶液通过校准的、对压力不敏感的泵分别以600 ml·h⁻¹和200 ml·h⁻¹的流速在透析单元之前注入。注入足够的柠檬酸盐以维持血路和透析器的凝血时间超过18分钟。将标准的10%氯化钙以7 mg·min⁻¹的恒定速率注入回输到患者体内的血液中。每次血液透析时，患者使用单通道系统透析4小时。透析过程顺利；未观察到活动性出血。血液透析期间患者的凝血时间显著缩短（从18.1±8.9分钟降至14.5±6.3分钟；p<0.001）。测量了220次血清柠檬酸盐水平。只有9次高于2 mmol·l⁻¹的中毒值。未发现离子钙降低的临床证据：校正后的QT间期和血压没有变化。（摘要截短至250字）
