脓毒症患者行局部枸橼酸抗凝持续肾脏替代治疗过程中钙的管理

Calcium management during continuous renal replacement therapy with regional citrate anticoagulation in patients with sepsis

脓毒症是指机体对感染的宿主反应失调导致的威胁生命的器官功能障碍[1]。CRRT是ICU中治疗脓毒症的重要措施之一。它可以改善脓毒症患者的器官功能,精确控制体液平衡,清除炎症介质等[2-5]。合理的抗凝剂和抗凝方法是确保CRRT顺利进行的重要部分。2012年肾病改善全球预后(KDIGO)临床实践指南建议,无论患者的出血风险和凝血状态如何,只要患者没有枸橼酸使用禁忌证,枸橼酸是行CRRT患者的首选抗凝剂[6]。

Sepsis is one of the most common fatal diseases in intensive care unit(ICU).If left untreated,sepsis may develop into severe sepsis,multiple organ dysfunction syndrome or even death.Continuous renal replacement therapy(CRRT)is an important method for the treatment of sepsis.Currently,regional citrate anticoagulation(RCA)is the preferred anticoagulation method for CRRT,among which ionic calcium([iCa])plays a key role.The disorder of calcium metabolism is associated with poor outcomes in patients with sepsis,so it is essential to maintain the balance of ion calcium in the body.This paper reviews the latest research results and clinical practice of calcium management in patients with sepsis undergoing regional citrate anticoagulation continuous renal replacement therapy(RCA-CRRT),in order to improve the level of understanding of blood purification therapy in patients with sepsis.