局部枸橼酸抗凝的连续肾脏替代治疗在脑出血并发急性肾损伤患者中的应用效果

Effect of continuous renal replacement therapy with regional citrate anticoagulation on intracerebral hemorrhage complicated with acute renal injury

目的评价局部枸橼酸抗凝(RCA)在脑出血合并急性肾损伤(AKI)患者连续性肾脏替代治疗(CRRT)中的效果及安全性。方法回顾性分析2013年2月至2018年2月西安交通大学第二附属医院收治的83例脑出血并发AKI需进行CRRT患者的临床资料。根据不同的抗凝方式将患者分为RCA组(41例)和无肝素抗凝(NA)组(42例)。比较2组患者一般临床资料、CRRT治疗期间相关临床指标、滤器使用时间和滤器及静脉壶凝血及相关并发症发生情况。结果2组患者一般临床资料以及CRRT治疗前各临床指标比较差异均无统计学意义(均P>0.05)。CRRT治疗72h后,RCA组血清肌酐、血乳酸水平明显低于NA组[(103±52)μmol/L比(142±25)μmol/L、(2.3±1.4)mmol/L比(3.5±1.0)mmol/L];RCA组血红蛋白、血小板计数明显高于NA组[(98±9)g/L比(85±5)g/L、(160±22)×10^9/L比(127±30)×10^9/L](均P<0.05)。RCA组单套滤器平均使用时间、滤器使用时间达标率均明显长于/高于NA组[(25±5)h比(14±3)h、86.7%(78/90)比56.8%(79/139)],RCA组滤器凝血、静脉壶凝血的发生率及严重程度均明显低于NA组(均P<0.01)。2组在CRRT治疗期间并发症发生率比较差异均无统计学意义(均P>0.05)。结论RCA应用于脑出血并发AKI患者进行CRRT抗凝治疗安全有效,能够明显提高滤过效率、延长滤器寿命并减少出血风险。

Objective To evaluate the safety and effect of regional citrate anticoagulation(RCA)on continuous renal replacement therapy(CRRT)in patients with intracerebral hemorrhage(ICH)complicated with acute kidney injury(AKI).Methods Clinical data of 83 patients with ICH and AKI who underwent CRRT in the Second Affiliated Hospital of Xi'an Jiaotong University were retrospectively analyzed.According to different anticoagulation methods,they were divided into RCA group(RCA group,41 cases)and non-heparin anticoagulation group(NA group,42 cases).Basic data,clinical indicators during CRRT,filter use time,coagulation of filter and venous pot,and related complications were analyzed.Results There were no significant differences of baseline indicators between groups(P>0.05).After 72 h of CRRT,levels of serum myostatin and lactic acid in RCA group were significantly lower than those in NA group[(103±52)μmol/L vs(142±25)μmol/L,(2.3±1.4)mmol/L vs(3.5±1.0)mmol/L];hemoglobin level and platelet count in RCA group were significantly higher than those in NA group[(98±9)g/L vs(85±5)g/L,(160±22)×10^9/L vs(127±30)×10^9/L](all P<0.05).Average filter use time and the rational rate of filter use time in RCA group were significantly longer/higher than those in NA group[(25±5)h vs(14±3)h,86.7%(78/90)vs 56.8%(79/139)](both P<0.05).Incidence and severity of filter coagulation and venous coagulation in RCA group were significantly lower than those in NA group(both P<0.01).There was no significant difference of the incidence of complications between groups(P>0.05).Conclusion RCA is safe and effective in CRRT for ICH patients with AKI;it can significantly improve filtration efficiency,extend filter life and reduce bleeding risk.