枸橼酸抗凝剂用于血液净化的临床研究进展

Research progress on application of blood purification using citrate anticoagulants

血液净化治疗过程中常面临管路凝血、出血风险等问题,正确选择抗凝剂是持续有效进行血液净化的关键。枸橼酸在体外循环管路中通过与钙离子螯合起到体外抗凝作用,其在体内迅速被氧化代谢而减少出血风险的发生。结合枸橼酸抗凝机制,回顾近年来国内外枸橼酸抗凝剂在高危出血患者持续性肾脏替代治疗(CRRT)、血液透析、血浆置换、以及在肝功能损害等患者中的临床应用,并分析了其在抗凝治疗过程中的限制点及风险,为进一步临床推广应用提供参考。

When blood purification was performed in patients with high risk of coagulation and bleeding, it is often confronted with the risk of blood clotting and bleeding. It is essential to choose the adequate anticoagulant in order to perform successful blood purification. Citrate anticoagulant works by chelating with calcium ion in extracorporeal circulation loop, and quickly goes through oxidative metabolism process and hence reduces the risk of bleeding. In this article, the anticoagulant mechanism of regional citrate anticoagulation has been induced. This article also reviews the application of citrate anticoagulation in CRRT for patients with high risk of bleeding, and introduces the anticoagulant effects in hemodialysis, plasma exchange, and the application of RCA in patients with liver function lesion. The limits and risks of citrate anticoagulation in treatment were then analyzed. These analyses can provide references for popularizing citrate anticoagulants in clinical application.