Ye Xinyu, Zhang Shuai, Tang Maoting
Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
BMC Pediatr. 2025 Jul 2;25(1):496. doi: 10.1186/s12887-025-05762-x.
Anticoagulants commonly used in the continuous veno-venous hemofiltration (CVVH) include unfractionated heparin, low-molecular-weight heparin, and sodium citrate. This study investigated the clinical anticoagulation effects of sodium citrate, low-molecular-weight heparin and non-heparin anticoagulants in critically ill children during CVVH.
This was a retrospective study based on the medical records of 86 critically ill children who were admitted to the Pediatric Intensive Care Unit of our hospital and received the CVVH treatment during January 2021 to May 2023. According to coagulation test results and choice of anticoagulant, 28 cases who received normal results in the coagulation tests and treated with low-molecular-weight heparin were classified into Group a1; 36 cases who received normal results in the coagulation tests and treated with 4% sodium citrate were classified into Group a2; 8 cases who received abnormal results in the coagulation tests and treated with a non-heparin anticoagulant were classified into Group b1; and 14 cases who received abnormal results in the coagulation tests and treated with 4% sodium citrate were classified into Group b2.
No statistically significant differences were identified in the results of blood gas and electrolyte tests before and after treatment (P > 0.05). The levels of creatinine, blood urea nitrogen and lactic acid after treatment were significantly lower than those before. No statistically significant differences were identified in activated partial thromboplastin time in Group a1 and Group a2 before and after treatment. The values of prothrombin time and platelet count in Group a2 were higher than Group a1 after treatment (P < 0.05). The incidences of treatment interruption caused by coagulation in groups a2 and b2 were lower than groups a1 and b1, respectively. Better performance was found in extending treatment duration, reducing coagulation in lines and filters and reducing the risk of bleeding in Group a2 compared with a1 (P < 0.05). No statistically significant differences were identified in the incidences of hypernatrium, hypocalcemia and acidosis/alkalosis (P > 0.05).
Sodium citrate is safer and more effective in anticoagulation during CVVH compared with low-molecular-weight heparin and non-heparin anticoagulants.
Not applicable.
连续静脉-静脉血液滤过（CVVH）中常用的抗凝剂包括普通肝素、低分子量肝素和枸橼酸钠。本研究探讨了枸橼酸钠、低分子量肝素和非肝素抗凝剂在危重症儿童CVVH期间的临床抗凝效果。
这是一项回顾性研究，基于我院儿科重症监护病房2021年1月至2023年5月收治的86例接受CVVH治疗的危重症儿童的病历。根据凝血检测结果和抗凝剂选择，凝血检测结果正常且接受低分子量肝素治疗的28例患儿分为a1组；凝血检测结果正常且接受4%枸橼酸钠治疗的36例患儿分为a2组；凝血检测结果异常且接受非肝素抗凝剂治疗的8例患儿分为b1组；凝血检测结果异常且接受4%枸橼酸钠治疗的14例患儿分为b2组。
治疗前后血气和电解质检测结果差异无统计学意义（P>0.05）。治疗后肌酐、血尿素氮和乳酸水平显著低于治疗前。a1组和a2组治疗前后活化部分凝血活酶时间差异无统计学意义。治疗后a2组凝血酶原时间和血小板计数高于a1组（P<0.05）。a2组和b2组因凝血导致的治疗中断发生率分别低于a1组和b1组。与a1组相比，a2组在延长治疗时间、减少管路和滤器凝血以及降低出血风险方面表现更好（P<0.05）。高钠血症、低钙血症和酸中毒/碱中毒的发生率差异无统计学意义（P>0.05）。
与低分子量肝素和非肝素抗凝剂相比，枸橼酸钠在CVVH期间抗凝更安全有效。
不适用。
