连续性肾脏替代治疗中局部枸橼酸抗凝的临床监测及风险评估

Clinical monitoring and risk assessment of regional citrate anticoagulation in continuous renal replacement therapy

安全有效的抗凝是血液净化成功实施的关键。局部枸橼酸抗凝较传统全身抗凝具有延长体外循环寿命同时降低出血并发症等优势,日渐受到重视。但局部枸橼酸抗凝略为复杂的实施方案,电解质和酸碱状态的紊乱以及在特殊人群中的蓄积风险使很多临床医生望而却步。该综述从局部枸橼酸抗凝的临床监测入手,分析并发症的发生原因及处理措施,介绍特殊人群中的风险评估,以期为局部枸橼酸抗凝在危重患者中的广泛开展提供帮助。

Safe and effective anticoagulation is the key to successful blood purification.Compared with traditional systemic anticoagulation,regional citrate anticoagulation(RCA)has the advantages of prolonging the life of extracorporeal circulation and reducing bleeding complications.However,the complex protocol,the disorder of electrolyte and acid-base status and the accumulation risk in special populations have dissuaded many clinicians.This review starts with the clinical monitoring of RCA,then analyzes the causes and treatments of complications.The risk assessments in special populations were also introduced in order to the widely promotion of RCA in critically ill patients.