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[1]项龙,任宏,奚悦玲,等.局部枸橼酸抗凝技术在儿童连续肾脏替代治疗中的临床应用[J].医学研究与战创伤救治(原医学研究生学报),2018,20(05):459-463.[doi:10.3969/j.issn.1672-271X.2018.05.003]
　XIANG Long,REN Hong,XI Yue-ling,et al.Clinical application of regional citrate anticoagulation in pediatrics continuous renal replacement therapy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(05):459-463.[doi:10.3969/j.issn.1672-271X.2018.05.003]
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局部枸橼酸抗凝技术在儿童连续肾脏替代治疗中的临床应用()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第20卷
期数:
2018年05期
页码:
459-463
栏目:
出版日期:
2018-09-18

文章信息/Info

Title:
Clinical application of regional citrate anticoagulation in pediatrics continuous renal replacement therapy
作者:
项龙; 任宏; 奚悦玲; 张建; 宁铂涛; 钱娟; 李璧如; 王莹
作者单位：200127上海，上海交通大学医学院附属上海儿童医学中心重症医学科（项龙、任宏、奚悦玲、张建、宁铂涛、钱娟、李璧如、王莹）
Author(s):
XIANG Long;  REN Hong;  XI Yue-ling;  ZHANG Jian;  NING Bo-tao;  QIAN Juan;  LI Bi-ru;  WANG Ying
(Department of Pediatrics Intensive Care Units，Shanghai Children’s Medical Center，Shanghai Jiaotong University School of Medicine, Shanghai 200127,China)
关键词:
局部枸橼酸抗凝; 连续性肾脏替代治疗; 出血; 儿童
Keywords:
regional citrate anticoagulation;  continuous renal replacement therapy;  bleeding;  pediatrics
分类号:
R720.597
DOI:
10.3969/j.issn.1672-271X.2018.05.003
文献标志码:
A
摘要:
目的 探讨局部枸橼酸抗凝（RCA）在儿童连续性肾脏替代治疗（CRRT）应用的有效性和安全性。方法 回顾性分析2016年7月至2018年1月上海儿童医学中心儿科重症监护病房(PICU)接受RCA抗凝CRRT治疗的20例患儿（枸橼酸组）的临床资料，另选择2007年12月至2015年7月接受传统肝素抗凝(HA)CRRT治疗的33例患儿（肝素组）作为对照，比较2组CRRT治疗滤器寿命、凝血指标[血小板计数、部分活化凝血活酶原时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（Fib）]、电解质变化[离子钙（Ca2+ion）、结合钙(Ca2+tot)、Ca2+tot/ Ca2+ion、pH值、碳酸氢根（HCO-3)]、肝功能[ 谷丙转氨酶(ALT）、总胆红素（TBil)]和活动性出血情况。结果 枸橼酸组滤器寿命较肝素组显著延长[(25.8±14.6)h vs (17.4±9.9)h，P＜0.01]，枸橼酸组治疗前后血小板计数、APTT、PT、Fib差异无统计学意义（P>0.05），肝素组CRRT治疗后较治疗前血小板明显下降[（95.6±15.5）×109/L vs (127.3±23.8)×109/L，P＜0.05]、APTT延长[（76.5±9.0）s vs （52.4±15.5）s, P＜0.05]。枸橼酸组与肝素组住PICU时间[（15.8±11.3）d vs （10.5±15.7）d]和PICU病死率（40.0% vs 33.0%）比较差异无统计学意义（P>0.05）。枸橼酸组治疗后较治疗前Ca2+tot升高[（2.54±0.40）mmol/L vs （2.25±0.45）mmol/L, P＜0.05],但治疗前后Ca2+ion、Ca2+tot/ Ca2+ion、pH、HCO-3、ALT、TBil比较差异无统计学意义（P>0.05）。枸橼酸组CRRT治疗期间无新发活动性出血，肝素组治疗期间新发6例肺出血，5例消化道出血，2例深静脉穿刺处皮肤出血。结论 RCA在危重症儿童CRRT治疗是安全、有效的抗凝方式。
Abstract:
Objective To evaluate the efficacy and safety of regional citrate anticoagulation in pediatrics continuous renal replacement therapy.Methods Retrospective analysis of the clinical data of 20 children treated with RCA during CRRT therapy in our PICU from July 2016 to January 2018（RCA group）,We also collected the clinical data of 33 children treated with heparin anticoagulation (HA group) during CRRT therapy from December 2007 to July 2015. Compared the clinical data, life of the filter, coagulation parameters,internal environment changes, complications and prognosis between two groups.Results The life span of the RCA group was prolonged significantly than HA group [(25.8±14.6)h vs(17.4±9.9)h,P＜0.01]. There was no significant difference in platelet counts, APTT, PT，FIB before and after CRRT therapy in RCA group（P>0.05，respectively）. Plt counts was decreased significantly[（95.6±15.5）×109/L vs (127.3±23.8)×109/L，P＜0.05] and APTT was prolonged significantly [（76.5±9.0）s vs （52.4±15.5）s, P＜0.05] before and after CRRT therapy in HA group. There was no significant difference between RCA and HA groups in stay in PICU times and PICU mortality [(15.8±11.3)d vs (10.5±15.7)d，40.0% vs 33.3%, P>0.05].In RCA group, Ca2+tot after CRRT was higher than before the treatment [(2.54±0.40)mmol/L vs (2.25±0.45) mmol/L,P＜0.05]. There was no significant difference between Ca2+ion, Ca2+tot/ Ca2+ion, pH, HCO-3 before and after CRRT（P>0.05,respectively）. In RCA group, there was no new active bleeding during CRRT treatment. In HA Group, 6 cases of pulmonary hemorrhage, 5 cases of gastrointestinal bleeding and 2 cases of deep venous puncture skin bleeding occurred during treatment.Conclusion RCA is a safe and effective anticoagulant method for CRRT in critically ill children.

参考文献/References:

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备注/Memo

备注/Memo:
基金项目：上海市卫生和计划生育委员会科研课题（201640202）；上海申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划项目（16CR3085B）；上海市卫生计生系统重要薄弱学科建设计划项目（2016ZB0104）
更新日期/Last Update: 2018-09-20