用于持续肾脏替代治疗的半自动局部枸橼酸盐抗凝：一项针对幼儿的观察性研究。
Semiautomated Regional Citrate Anticoagulation for Continuous Kidney Replacement Therapy: An Observational Study in Young Children.
作者信息
Liet Jean-Michel, Baleine Julien, Demaret Pierre, Mounier Sophie, Porcheret Florence, Joram Nicolas, Chenouard Alexis
机构信息
Division of Pediatric Critical Care Medicine, Department of Neonatal Medicine and Pediatric Intensive Care, University Hospital of Nantes, Nantes, France.
Division of Pediatric Critical Care Medicine, Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, Montpellier, France.
出版信息
Pediatr Crit Care Med. 2022 Sep 1;23(9):e429-e433. doi: 10.1097/PCC.0000000000002993. Epub 2022 May 17.
OBJECTIVES
To review use of semiautomated regional citrate anticoagulation (saRCA) for continuous kidney replacement therapy (CKRT) in young children.
DESIGN
Retrospective cohort study.
SETTING
Three independent PICUs.
PATIENTS
All consecutive children weighing less than 11 kg who received CKRT with saRCA from January 2015 to June 2020.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Twenty-one children weighing less than 11 kg underwent CKRT with saRCA. The total duration of the CKRT was 2,014 hours, with a total of 64 CKRT sessions. Citrate intoxication occurred in four of 64 CKRT sessions (6%). Citrate intoxication was consistently observed in the few CKRT sessions where the initial lactate concentration was greater than 4 mmol/L or the ratio of replacement fluid flow to citrate flow less than 50%. The rate of unscheduled interruptions of CKRT sessions was 25% (16/64).
CONCLUSIONS
We have used saRCA for CKRT in children weighing less than 11 kg. A strict protocol and intensive training are required to minimize complications.
目的
回顾半自动局部枸橼酸抗凝（saRCA）在幼儿持续肾脏替代治疗（CKRT）中的应用。
设计
回顾性队列研究。
地点
三个独立的儿科重症监护病房。
患者
2015年1月至2020年6月期间所有体重小于11千克且接受saRCA进行CKRT的连续患儿。
干预措施
无。
测量指标及主要结果
21名体重小于11千克的儿童接受了saRCA的CKRT治疗。CKRT的总时长为2014小时，共进行了64次CKRT治疗。64次CKRT治疗中有4次（6%）发生枸橼酸中毒。在初始乳酸浓度大于4毫摩尔/升或置换液流速与枸橼酸流速之比小于50%的少数CKRT治疗中，持续观察到枸橼酸中毒。CKRT治疗计划外中断率为25%（16/64）。
结论
我们已将saRCA用于体重小于11千克儿童的CKRT治疗。需要严格的方案和强化培训以尽量减少并发症。
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