局部枸橼酸钠抗凝连续性肾替代治疗中可通过管路采血监测钙浓度

Sampling blood through vessel with hemodialysis catheter for monitoring iCa^(2+) in patients with CRRT and regional citrate anticoagulation

目的:探讨对重症医学科(ICU)行局部枸橼酸钠抗凝(RCA)的连续性肾替代治疗(CRRT)患者通过管路采血检测钙离子(iCa^(2+))浓度的可行性。方法:回顾性分析2015年1月-2019年7月入住南通大学附属海安医院ICU患者100例,其中使用普通CRRT机器的患者50例,使用Ci-Ca专用仪器的患者50例。同时采集血滤管路内血液样本和动脉血,分别检测iCa^(2+)浓度,并采用Bland-Altman法分析2种采血方式血液iCa^(2+)浓度。观察患者一次性穿刺成功率和采血点不良反应发生率。结果:普通CRRT组和Ci-Ca专用CRRT组患者血滤管路采血和动脉采血,血液iCa^(2+)浓度差异无统计学意义[(1.058±0.083)mmol/L vs(1.069±0.085)mmol/L,(1.069±0.086)mmol/L vs(1.076±0.085)mmol/L,P均>0.05]。绘制Bland-Altman散点图,2组患者血滤管路采血和动脉采血的血液iCa^(2+)浓度具有一致性(P=0.0688,0.0599)。普通CRRT组血管内采血一次穿刺成功率为94.0%,穿刺位点渗血、淤青、血肿等不良反应发生率分别为10%、16%、8%,而血滤管路采血则未发生上述不良反应,且一次穿刺成功率均为100%。结论:对于行RCA-CRRT治疗的ICU高危患者,通过血滤管路采血检测的iCa^(2+)浓度与动脉血iCa^(2+)浓度具有一致性,在密切监测iCa^(2+)浓度的前提下可代替动脉穿刺采血。

Objective:To observe the feasibility study on sampling blood through vessel with hemodialysis catheter for monitoring ionized calcium(iCa^(2+))during continuous renal replacement therapy(CRRT)with regional citrate anticoagulation(RCA).Methods:A total of 100 ICU patients who underwent RCA-CRRT in our hospital from January 2015 to July 2019 were retrospectively selected as the research subjects and divided into traditional CRRT group and Ci-Ca special CRRT group with 50 cases in each group.Sample arterial blood through hemodialysis catheter and arteries in traditional CRRT group,and sample blood through Ci-Ca catheter and arterial intubation in Ci-Ca special CRRT group was collected.iCa^(2+) concentrations were detected by blood gas analyzer.Bland-Altman plot method was used to detect the consistency of iCa^(2+) concentrations.Results The iCa^(2+) concentrations in hemodialysis catheter and arteries in traditional CRRT group were respectively(1.058±0.083)mmol/L and(1.069±0.085)mmol/L,and there was no statistical difference by paired-samples t test(P>0.05).The iCa^(2+) concentrations in Ci-Ca catheter and arterial intubation in Ci-Ca special CRRT group were respectively(1.069±0.086)mmol/L and(1.076±0.085)mmol/L,and there was no statistical difference by paired-samples t test(P>0.05).Bland-Altman plot method showed the difference in iCa^(2+) concentrations between hemodialysis catheter and arteries in traditional CRRT group or Ci-Ca catheter and arterial intubation in Ci-Ca special CRRT group without significant difference(P=0.0688,0.0599).In traditional CRRT group,the successful rate of one-time puncture was 94.0%,and the incidence of bleeding,bruising and hematoma at the puncture site was 10%,16%and 8%respectively,but the success rate of one puncture was 100%through catheters.Conclusions:During CRRT with regional 4%citrate anticoagulation,blood sampling through hemodialysis catheter or Ci-Ca catheter would replace the blood sampling through arteries under the condition of closely monitoring iCa^(2+) concentrations of precursors.