Weinstein R
Department of Medicine, St. Elizabeth's Medical Center of Boston, MA 02135, USA.
J Clin Apher. 1996;11(4):204-10. doi: 10.1002/(SICI)1098-1101(1996)11:4<204::AID-JCA5>3.0.CO;2-F.
We have examined the effectiveness of intravenous calcium gluconate infusion in the prevention of citrate reactions during therapeutic plasma exchange. Over 3 years, 636 procedures were performed on 90 patients, mostly for treatment of neurological disorders. Return fluid consisted of 4-5% human serum albumin in 0.9% NaCl. Anticoagulant ACD-A was used at a starting ratio of 1:16. Whole blood flow rates were 70-80 ml/min. Treatments were divided into three groups for management of citrate reactions: Group A (360 treatments) were managed using simple measures only, including slowing the whole blood flow rate, altering the ACD:whole blood flow ratio, and oral calcium carbonate wafers; Group B (102 treatments) received small intravenous boluses of 10% calcium gluconate, us to 25 ml during the procedure; Group C (174 treatments) received constant infusion of calcium gluconate (10 ml/liter of return fluid) during the procedure. Citrate reactions occurred in 35.6% of Group A and 29.4% of Group B treatments (P = 0.3), but in only 8.6% of Group C treatments (P < 0.0001). Men with and without reactions were the same age (mean 63.3 vs. 61 years, P = 0.0823), but women with reactions were younger than women without reactions (mean 49.9 vs. 57.9 years, P < 0.0001). Supplementation of the return fluid with calcium gluconate is an effective, convenient, and well-tolerated method for prevention of citrate toxicity during therapeutic plasma exchange procedures using albumin-based return fluid.
我们研究了静脉输注葡萄糖酸钙在治疗性血浆置换过程中预防枸橼酸盐反应的有效性。在3年多的时间里，对90例患者进行了636次操作，主要用于治疗神经系统疾病。回输液为0.9%氯化钠中含4 - 5%人血清白蛋白。抗凝剂ACD - A的起始比例为1:16。全血流速为70 - 80毫升/分钟。治疗分为三组来处理枸橼酸盐反应：A组（360次治疗）仅采用简单措施处理，包括减慢全血流速、改变ACD与全血的流速比以及口服碳酸钙片；B组（102次治疗）在操作过程中接受小剂量静脉推注10%葡萄糖酸钙，每次最多25毫升；C组（174次治疗）在操作过程中接受葡萄糖酸钙持续输注（每升回输液中含10毫升）。A组治疗中35.6%发生了枸橼酸盐反应，B组治疗中29.4%发生了反应（P = 0.3），但C组治疗中仅8.6%发生了反应（P < 0.0001）。有反应和无反应的男性年龄相同（平均63.3岁对61岁，P = 0.0823），但有反应的女性比无反应的女性年轻（平均49.9岁对57.9岁，P < 0.0001）。在使用基于白蛋白的回输液进行治疗性血浆置换过程中，向回输液中补充葡萄糖酸钙是预防枸橼酸盐毒性的一种有效、方便且耐受性良好的方法。
