局部枸橼酸抗凝在连续性肾脏替代治疗中的应用要点

Application of local citrate anticoagulation in continuous renal replacement therapy

体外循环抗凝是连续性肾脏替代治疗(continuerenal replacement therapy,CRRT)顺利实施的重要环节,不合适的抗凝方案可导致患者体外循环凝血、血液丢失、血液高凝、血栓栓塞性疾病,严重者可危及生命。局部枸橼酸抗凝(regional citrate anticoagulation,RCA)由于具有抗凝效果确切、出血风险小等优势,在CRRT中广泛应用,特别适用于合并高出血风险疾病的患者,但目前在临床上应用方案尚无统一标准。本文就CRRT中应用RCA的技术要点和相关注意事项进行简要介绍,以便更好地指导临床应用。

Anticoagulation in extracorporeal circulation is an important step for successful implementation of continuous renal replacement therapy(CRRT).Inappropriate anticoagulation regimen will cause blood coagulation in extracorporeal circulation,blood loss,hypercoagulation status or thromboembolic diseases,which are life-threatening in severe cases.Regional citrate anticoagulation(RCA)with its advantages of effective anticoagulation and lower bleeding risk is widely used in CRRT,especially for patients with bleeding risk.However,there are no standard protocols yet for clinical application.This article briefly introduces the technical essentials and precautions of RCA for its better use in CRRT.