连续性肾脏替代治疗中抗凝剂的应用现状及发展方向

Application Status and Development Direction of Anticoagulant in Continuous Renal Replacement Therapy

连续性肾脏替代治疗(CRRT)技术是目前危重症医学上重要的器官支持手段之一。由于其治疗时间较间歇性血液透析明显延长,因此对抗凝的要求更高。本文综述了目前CRRT中常用的抗凝剂的应用现状。普通肝素(UFH)抗凝仍然是目前国内CRRT最常用的抗凝方法之一,但其不良反应需引起重视,主要包括:出血发生率高,易发生肝素诱导性血小板减少症(HIT),肝素抵抗等。低分子肝素(LMWH)与肝素比较,引发出血并发症几率更低,但剂量不易控制,监测手段复杂,限制了其广泛应用。局部枸橼酸抗凝(RCA)易于使用,而且已被证明能延长滤器寿命并且无全身抗凝危险,是CRRT重要且最有发展力的抗凝方法之一。近年来RCA的标准化方案及预冲配方成为枸橼酸抗凝领域新兴的研究热点。

Continuous renal replacement therapy（CRRT） technique is one of the important means of organ support in critical care medicine. Due to its treatment time is significantly longer than intermittent hemodialysi, the requirement for anticoagulation is even more. This paper reviews the current application status of commonly used anticoagulant in CRRT. At present, unfractionated heparin（UFH） remains one of the most commonly used anticoagulant method for domestic CRRT, but its adverse reactions should be paid attention, mainly including high incidence rate of bleeding, heparin-induced thrombocytopenia（HIT）, heparin resistance, etc. Compared with heparin, the rate of low molecular weight heparins（LMWH） caused bleeding complications is lower, but the dose is difficult to control and the monitoring method is complex, which limits its wide use. Regional citrate anticoagulation（RCA） is one of the important and promising anticoagulant methods for CRRT because it＇s easy to use, and has been testified to extend the life of the filter without systemic anticoagulation danger. In recent years, standardized solution of RCA and preflush formula become a hot spot in the field of citrate anticoagulation.