局部枸橼酸抗凝在重症患者肝功能异常中的应用

Regional citrate anticoagulation in criticalpatients with liver dysfunction

目的探讨局部枸橼酸抗凝在重症患者肝功能异常时行连续性静脉一静脉血液滤过（CVVH）应用的安全性。方法采用回顾性研究方法，收集我院重症医学科2014—01～2014—06用局部枸橼酸抗凝行连续性肾替代治疗（CRRT）数据齐全的患者77例，分为A组（肝功能正常组）、B组（肝功能异常组，终末期肝病模型MELD评分≤25．13分）、C组（肝功能异常组MELD评分〉25．13分）。观察CRRT开始前2h与结束后6h患者的血气分析、乳酸、体内钙离子、总钙等指标的变化。结果共收集77例患者103例次CRRT。A、B、C三组CRRT结束后6h体内钙离子、总钙、全血剩余碱均明显高于CRRT前2h（P〈0．05），但CRRT结束后6h，三组比较差异均无统计学意义（P〉0．05），三组CRRT结束后6h体内pH值及乳酸与CRRT前2h比较差异均无统计学意义（P〉0．05）。结论各种病因导致的肝功能异常患者行CVVH时用局部枸橼酸抗凝是安全的，不引起体内酸碱平衡及电解质代谢紊乱。

Objective To explore the safety of regional citrate anticoagulation forcontinuous veno- venous hemofihration （CVVH） in critical patients with liver dysfunction. Methods 77 patients underwent continuous renal replacement therapy （CRRT） using citrate as anticoagulation were retrospectively included in this study. The patients were divided into group A （normal liver function） , group B （ liver dysfunction MELD ≤25.13 ） and group C （ liver dysfunction MELD 〉 25.13 ）. Respective values of blood gas （pH, base excess）, lactic acid, ionized calcium and total calcium in 2 hours prior to CRRT and 6 hours after CRRT were observed and analyzed. Results A total of 77 patients （ 103 cases of CRRTs） were included in the study. Comparing to 2 hours prior to CRRT, the ionized calcium, total calcium and base excess in 6 hours ＇after CRRT were significantly higher in all groups （ P 〈 0.05 ） , pH and lactic acid in 6 hours after CRRT were similar in all groups （ P 〉 0.05 ）. Ionized calcium, total calcium, base excess were not significantly different in 3 groups in 6 hours after CRRT （ P 〉 0.05 ）. Conclusions Regional eitrateanticoagulation in CVVH does not cause acid- base balance and electrolyte disorder. Thus it is safe to operate in liver dysfunction patients.