连续性肾脏替代治疗中局部枸橼酸抗凝的应用

Application of Local Citrate Anticoagulation in Continuous Renal Replacement Therapy

连续性肾脏替代治疗(CRRT)中有效透析剂量的输送取决于体外回路的充分抗凝。在大多数患者中,使用全身肝素抗凝或局部枸橼酸盐抗凝(RCA)。本综述将概述RCA的基础和原理,并总结两种技术的安全性和有效性数据。RCA的基本原理是通过输注枸橼酸盐来降低体外回路中的离子钙水平,通过这种方式,实现了仅限于体外回路的有效抗凝。在不同的研究中,对肝素抗凝与RCA进行了比较。RCA可明显地提高过滤器的使用寿命,降低出血并发症,并能很好地控制尿毒症及酸碱平衡,并且对大部分肝脏损伤患者也都是安全的。在CRRT中,RCA是一种安全、有效的抗凝治疗方法,其抗凝效果优于肝素抗凝,并可降低不良反应。在ICU患者中,大多数CRRT治疗均可推荐RCA抗凝模式。

The delivery of an effective dialysis dose in continuous renal replacement therapy (CRRT) depends on adequate anticoagulation of the extracorporeal circuit. In most patients, either systemic heparin anticoagulation (SHA) or regional citrate anticoagulation (RCA) is used. This review will outline the basics and rationale of RCA and summarize data on safety and efficacy of both techniques. The basic principle of RCA is to reduce the level of ionized calcium in the extracorporeal circuit via infusion of citrate. This way, effective anticoagulation restricted to the extracorporeal circuit is achieved. SHA and RCA were compared in a variety of studies. RCA significantly prolonged filter lifetime, reduced bleeding complications and provided excellent control of uremia and acid-base status. RCA was also safe in the majority of patients with impaired liver function.RCA per se is safe and effective for anti-coagulation of CRRT. Compared to SHA, efficacy of anticoagulation is improved and adverse effects are reduced. RCA can be recommended as the anticoagulation mode of choice for CRRT in most ICU patients.