Effect Of Regional Citrate Anticoagulation In Continuous Renal Replacement Therapy

BackgroundContinuous renal replacement therapy（CRRT）is a group of extracorporeal blood purification treatment technology that have successfully treated many critically ill patients since its application,with its unique clinical advantages.Because of the special treatment that requires blood to be taken out of circulation and the duration of treatment is often longer,how to ensure safe and effective anticoagulation has become the key to successful treatment.In this regard,scholars at home and abroad have done a lot of tireless research and tried many different anticoagulation methods.It is found that regional citrate anticoagulation（RCA）has prominent effect in CRRT,and has fewer complications.It has been widely applied in clinical practice.ObjectiveThis article analyzes the changes of various experimental indexes before and after treatment in critically ill patients treated with two different anticoagulation methods:citrate and low molecular weight heparin to investigate the safety and efficacy of citrate anticoagulation in CRRT.MethodsThe clinical data of 68 critically ill patients admitted to intensive care unit（ICU）from June 2016 to August 2017 in Nanyang Central Hospital were collected.According to the anticoagulation method,they were divided into regional citrate anticoagulation group（RCA group）and low-dose low molecular weight heparin anticoagulation group（control group）.The electrolyte and blood gas analysis(Na⁺、K⁺、iCa²⁺、pH、HCO₃^-、Lac),Blood routine（WBC、Hb、PLT）,activated partial thromboplastin time（APTT）,blood urea nitrogen（BUN）,serum creatinine（Scr）and the number of cases of post-treatment hemorrhage,coagulation of extracorporeal circulation were observed before and after treatment in both groups,and record the filter life.Results1.Of these 68 critically ill patients,49（72.1%）were males,19（27.9%）were females,34（23 males and 11 females）were in the RCA group,aged from 24 to 83 years old,and the average age was（54.06?15.53）years old.34 patients of control group（26males and 8 females）,aged from 30 to 76 years old,mean age（53.79?13.28）years old.Before CRRT treatment,there was no statistical difference between the two groups in age,gender,APACHE-II score and primary disease（P>0.05）.2.Before CRRT of the two groups of patients,the serum sodium（Na⁺）,serum potassium（K⁺）,serum calcium(iCa²⁺),blood pH（PH）,bicarbonate（HCO₃^-）,lactic acid（Lac）,white blood cell（WBC）,hemoglobin（Hb）,platelet count（PLT）,activated partial thromboplastin time（APTT）,blood urea nitrogen（BUN）and creatinine（Cr）were compared,P>0.05,the difference was not statistically significant.3.Comparing the indexes between the two groups after treatment,APTT value in control group was significantly longer than that in RCA group（P<0.05）,the difference was statistically significant.After the two groups of treatment,ionized calcium decreased compared with that before treatment,but the difference between the two groups was not statistically significant.After treatment,the Hb,BUN and Cr values in the two groups were compared（P>0.05）,and the difference was not statistically significant.The indicators K+,WBC,Lac of the two groups of patients before and after treatment were within the Intra-group comparison（P>0.05）,the difference was statistically significant.RCA group after treatment the indicators Na⁺,HC0₃^-increased compared with before treatment,but still within the normal range.The BUN and Cr in both groups decreased significantly after treatment（P<0.01）,the difference was statistically significant.4.Two groups of blood purification treatment 70 times,the incidence of coagulation events in the control group was higher than that in the RCA group.In the control group,bleeding occurred in 6 patients and the anticoagulation program was replaced.The incidence of hemorrhage in control group was higher than that in RCA group（P<0.01）,the difference was statistically significant.5.The service lives of the two filters were（18.14?11.86）h and（12.68?7.57）h,respectively.The average life span of filters in control group was lower than that of RCA group（P<0.01）,the difference was statistically significant.Conclusion1.By comparing the clinical indicators of two groups before and after treatment,both urea nitrogen and creatinine in the body can be effectively removed,and the body can maintain the balance of water electrolytes and acid-base stability.2.Compared with the control group,the RCA group had a lower risk of hemorrhage and a smaller impact on the autocoagulative system.The clotting blood filter had a lower incidence of blood clotting and had a longer lifespan.It had an advantage in CRRT applications where treatment time was relatively long.