局部枸橼酸抗凝在肝损伤儿童连续性肾脏替代治疗中的临床应用
Clinical application of regional citrate anticoagulation for continuous renal replacement therapy in children with liver injury.
作者信息
Hu Fang, Sun Yuelin, Bai Ke, Liu Chengjun
机构信息
Intensive Care Unit, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Children Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
The People's Hospital of Qijiang District, Chongqing, China.
出版信息
Front Pediatr. 2022 Oct 11;10:847443. doi: 10.3389/fped.2022.847443. eCollection 2022.
BACKGROUND
Regional citrate anticoagulation (RCA) is increasingly used for continuous renal replacement therapy (CRRT) in children, but it is rarely used in children with liver injury, especially liver failure (LF). We analyze this issue through the following research.
METHODS
We retrospectively analyzed 75 children with liver injury who underwent RCA-CRRT in the Pediatric Intensive Care Unit (PICU) of Children's Hospital of Chongqing Medical University. The patients were divided into the LF group and liver dysfunction (LD) group. The two groups were compared to evaluate the clinical safety and efficacy of RCA-CRRT in children with liver injury and to explore RCA-CRRT management strategies, in terms of the following indicators: the incidence of bleeding, clotting, citrate accumulation (CA), acid-base imbalance, and electrolyte disturbance, as well as filter lifespans, changes in biochemical indicators, and CRRT parameters adjustment.
RESULTS
The total incidence of CA (TCA) and persistent CA (PCA) in the LF group were significantly higher than those in the LD group (38.6 vs. 16.2%, < 0.001; 8.4 vs. 1.5%, < 0.001); and the CA incidence was significantly reduced after adjustment both in the LF (38.6 vs. 8.4%, < 0.001) and LD groups (16.2 vs. 1.5%, < 0.001). The incidence of hypocalcemia was significantly higher in the LF group than in the LD group either before (34.9 vs. 8.8%, < 0.001) or after treatment (12.0 vs. 0%, < 0.001). The speed of the blood and citrate pumps after adjustment was lower than the initial setting values in both the LF and LD groups. The dialysis speed plus replacement speed were higher than the initial settings parameters.
CONCLUSION
For children undergoing RCA-CRRT, the risks of CA and hypocalcemia are significantly higher in children with liver failure than those with liver dysfunction, but through the proper adjustment of the protocol, RCA-CRRT can still be safely and effectively approached for children with LD and even LF.
背景
局部枸橼酸抗凝（RCA）在儿童连续性肾脏替代治疗（CRRT）中应用越来越广泛，但在肝损伤尤其是肝衰竭（LF）患儿中应用较少。我们通过以下研究分析此问题。
方法
回顾性分析重庆医科大学附属儿童医院重症监护病房（PICU）接受RCA-CRRT治疗的75例肝损伤患儿。将患者分为LF组和肝功能不全（LD）组。比较两组以评估RCA-CRRT在肝损伤患儿中的临床安全性和有效性，并从以下指标探讨RCA-CRRT管理策略：出血、凝血、枸橼酸蓄积（CA）、酸碱失衡及电解质紊乱的发生率，以及滤器使用寿命、生化指标变化和CRRT参数调整情况。
结果
LF组CA总发生率（TCA）和持续性CA（PCA）显著高于LD组（38.6%对16.2%，<0.001；8.4%对1.5%，<0.001）；调整后LF组（38.6%对8.4%，<0.001）和LD组（16.2%对1.5%，<0.001）的CA发生率均显著降低。LF组低钙血症发生率在治疗前（34.9%对8.8%，<0.001）和治疗后（12.0%对0%，<0.001）均显著高于LD组。调整后LF组和LD组血泵和枸橼酸泵速度均低于初始设定值。透析速度加置换速度高于初始设定参数。
结论
对于接受RCA-CRRT治疗的儿童，肝衰竭患儿发生CA和低钙血症的风险显著高于肝功能不全患儿，但通过适当调整方案，LD甚至LF患儿仍可安全有效地进行RCA-CRRT治疗。
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