局部枸橼酸抗凝在连续肾脏替代治疗患者中的应用范围综述

A scoping review in the application of regional citrate anticoagulation in patients undergoing continuous renal replacement therapy

目的 基于范围综述的方法,汇总分析局部枸橼酸抗凝(RCA)在连续肾脏替代治疗(CRRT)患者中的应用情况。方法 根据范围综述的研究方法,系统检索中国知网、万方数据库、Cochrane Library、PubMed、Embase等国内外数据库中的CRRT患者应用RCA相关文献,检索时限为建库至2023年8月10日,对纳入文献进行筛选、汇总和分析。结果 本研究最终纳入19篇文献,包括随机对照试验8篇、队列研究8篇、病例对照研究2篇和横断面调查1篇。CRRT的抗凝方式主要包括普通肝素、低分子肝素、凝血酶抑制剂、萘莫司他和RCA等;相较于其他抗凝方式,RCA具有出血风险较低、滤器寿命更长的优势。RCA应用过程中的钙离子监测目前多采用经验试错法;RCA的主要并发症包括枸橼酸蓄积、酸碱平衡紊乱和离子代谢紊乱等;对于高出血风险患者、高钙血症患者和脓毒血症患者而言,CRRT过程中选用RCA可能收益更大。结论 RCA已经逐渐成为CRRT患者的首选抗凝方式,其具有延长滤器使用寿命、降低出血风险的优势。未来,研究人员应注重RCA应用过程中的钙离子监测,通过靶向输注系统提高安全性和有效性,并进一步探讨RCA的免疫调节作用及其炎症因子清除率高的相关机制。

Objective To summarize and analyze the application of regional citrate anticoagulation(RCA) in patients undergoing continuous renal replacement therapy(CRRT) using a scoping review methodology.Methods Following the scoping review methodology,a systematic search was conducted in domestic and international databases,including CNKI,Wanfang Data,Cochrane Library,PubMed,and Embase for literature related to RCA in CRRT patients.The search was limited from the inception of the databases to August 10,2023.Included studies were screened,summarized,and analyzed.Results A total of 19 articles were included in this study,comprising 8 randomized controlled trials,8 cohort studies,2 case-control studies,and 1 cross-sectional survey.Anticoagulation methods for CRRT primarily included unfractionated heparin,low-molecular-weight heparin,thrombin inhibitors,nafamostat,and RCA.Compared to other anticoagulation methods,RCA exhibited advantages in lower bleeding risk and longer filter lifespan.Calcium ion monitoring during RCA application predominantly relies on the empirical trial-and-error approach.Major complications associated with RCA include citrate accumulation,acid-base imbalance,and ion metabolic disorders.For patients with high bleeding risk,hypercalcemia,and sepsis,RCA may confer greater benefits during CRRT.Conclusion RCA has gradually emerged as a preferred anticoagulation method for CRRT patients,offering advantages in extending filter lifespan and reducing bleeding risk.Future research should focus on calcium ion monitoring during RCA,enhancing safety and efficacy through targeted infusion systems,and further exploring the immunomodulatory effects of RCA and its mechanisms related to high inflammatory factor clearance rates.