枸橼酸局部抗凝在危重患者血液滤过中的应用

Regional citrate anticoagulation for hemofiltration in critically ill patients

相对于普通肝素的系统性抗凝，枸橼酸在血液净化中只产生局部抗凝作用。其具有良好的抗凝效果，延长滤器使用时间，减少出血风险及降低输血需求。枸橼酸局部抗凝在危重患者连续性肾脏替代治疗（CRRT）中的地位应得到重视。本文从作用机制、代谢、抗凝的优势及并发症方面介绍枸橼酸局部抗凝。

Compared with the systemic anticoagulation of unfractionated heparin, citrate provides regional anticoagulation of the circuit in blood purification. Citrate shows efficient anticoagulation effect and prolongs filter lifespan; it reduces the risk of bleeding and the need for blood transfusion. The role of regional citrate anticoagulation in critically ill patients with continuous renal replacement therapy （CRRT） will be more important. The mechanism, metabolism, advantages and complications of the regional citrate anticoagulation will be review in this paper.