局部枸橼酸抗凝在肝衰竭患者进行持续肾脏替代治疗中的应用进展

Advances in the application of regional citrate anticoagulation for continuous renal replacement therapy in patients with liver failure

持续肾脏替代治疗（CRRT）技术是目前危重症医学上重要的器官支持手段之一，由于其持续时间长，抗凝是其治疗过程中必不可少的一个环节。肝衰竭患者常常存在凝血功能障碍，肝素抗凝会增加出血的风险，而无肝素抗凝易发生凝血堵管、患者容量负荷增大、血流动力学不稳定与护理工作负荷大等问题，因此，滤器局部枸橼酸抗凝（RCA）就成为肝衰竭患者中进行CRRT治疗时的主要抗凝方式。现就肝衰竭接受CRRT过程中应用RCA的机制、适应证及优缺点进行综述。

Currently, continuous renal replacement therapy （CRRT） is one of the most important means of organ support methods in critical care medicine. Anticoagulation is an essential part of the treatment process due to its prolonged duration. Patients with liver failure often have coagulation dysfunction and heparin anticoagulant can increase the risk of bleeding, but without hepafin anticoagulant, coagulation can easily occur./n addition, an increased volumetric load, hemodynamic instability, nursing workload and other problems are major issues. Therefore, regional citrate anticoagulation （RCA） is the main anticoagulant method for CRRT therapy in patients with liver failure. This article reviews the mechanism, indications, advantages and disadvantages of using RCA to CRRT in henatic failnre.