改良局部枸橼酸抗凝在儿童血液滤过的应用

Application of improved regional citrate anticoagulation in child hemofiltration

目的探讨透析泵泵注枸橼酸在儿童局部枸橼酸抗凝(RCA)连续性血液滤过(CHF)中的应用。方法回顾性分析2015年9月至2017年1月重庆医科大学附属儿童医院重症监护室49例行RCA-CHF治疗患儿的临床资料,分为传统组20例行RCA-CHF治疗;改良组29例(以透析泵泵注枸橼酸)在连续性血液透析滤过模式下行RCA-CHF治疗。观察输液泵气泡报警、采血不良、出凝血等不良事件,滤器寿命及枸橼酸抗凝常见并发症等发生情况。结果两组气泡报警、滤器寿命比较,差异有统计学意义(P<0.05);两组治疗前后生化指标比较中,Na^+、iCa^(2+)、TCa^(2+)/iCa^(2+)及HCO_3^-比较,差异均有统计学意义(P<0.05),但治疗前、后改良组与传统组Na^+、iCa^(2+)、TCa^(2+)/iCa^(2+)及HCO_3^-比较,差异均无统计学意义(P>0.05)。结论透析泵代替枸橼酸泵的改良技术可以更安全有效地用于儿童RCA-CHF治疗。

Objective To investigate the application of citrate injected by dialysis pump in regional citrate anticoagulation（RCA）for child continuous hemofiltration（CHF）.Methods The clinical data of 49 children patients with RCA-CHF with citrate anticoagulation in ICU of the Affiliated Children′s Hospital of Chongqing Medical University from September 2015 to January 2017 were retrospectively analyzed.All cases were divided into the traditional group（20 cases）for conducting RCA-CHF treatment and improved group（29 cases,dialysis pump injection of citric acid）for conducting RCA-CHF under CHF mode.The occurence situation of common complications such as infusion pump bubble alarming,blood undesirable collection,bleeding and coagulation,and complications such as filter lifetime and citrate anticoagulation were observed.Results The bubble alarming and filter lifetime had statistical difference between the two groups（P0.05）.The biochemical indicators before and after treatment,and Na^＋,iCa^2＋,TCa^2＋/iCa^2＋ and HCO3^- before and after treatment had statistical difference between the two groups.But Na^＋,iCa^2＋,TCa^2＋/iCa^2＋ and HCO3^- before and after treatment had no statistical difference between the improved group and traditional group（P0.05）.Conclusion The improved technology of dialysis pumps instead of citrate pumps can more safely and more effectively use in child RCA-CHF treatment.