| Objective:In this study,sodium citrate was injected into the arterial end(before the filter)and the venous pot in two sections to reduce the incidence of coagulation in the venous pot.To evaluate its efficacy and safety in continuous veno-venous hemodiafiltration(CVVHDF).Methods:1.Grouping method: This study was a prospective randomized controlled study of 120 patients receiving continuous veno-venous hemodiafiltration therapy with sodium citrate anticoagulation in the First Hospital of Jilin University from February 2020 to November2020,including 68 males and 52 females,the youngest aged 20 years and the oldest aged 86 years.According to random number table method,they were divided into experimental group and control group,including 60 cases in the experimental group and 60 cases in the control group.2.Intervention measures: experimental group: segmented sodium citrate anticoagulant was used,4% sodium citrate was injected into the arterial end(before the filter)and the venous pot at a rate of 10:1.Control group: Conventional 4% sodium citrate was injected arterial(before filter).The replacement solution of the two groups was injected with calcium-containing replacement solution(calcium ion content was 1.5mmol/L)and then diluted.Supplement calcium ions from the back of the filter according to the patient’s actual situation.3.Baseline data collection: patient name,gender,age,APACHE-Ⅱ score.4.Outcome indicators: During the first continuous veno-venous hemodiafiltration,the patient’s condition was closely monitored.During the treatment,the patients’ vital signs,coagulation conditions of the two sets of filters and venous pot,bleeding,alkalosis,hypernatremia and other complications were recorded.Biochemistry,blood routine,blood gas analysis,coagulation function,transmembrane pressure,transfusion pressure and other data of patients before,during and at the end of treatment were collected for statistical analysis to compare the differences in the indicators of treatment methods between the two groups,so as to test the safety and effectiveness of the test group.The main outcome indexes were: venous pot coagulation rate.Secondary outcome indicators included: safety indicators: complication rate,p H value,residual alkali,calcium ion,sodium ion,FIB,APTT,PT;The effectiveness indexes were: filter service time,TMP,reinfusion pressure,sodium citrate dose,and blood SCR level.Results:1.Baseline data: There were no statistically significant differences in age,gender,APACHE-Ⅱ score between the experimental group and the control group(P > 0.05).2.Outcome indicators: The incidence of venous pot coagulation in the test group was0%.In the control group,there were 8 cases of secondary venous pot clotting,and the incidence of venous pot clotting was 13.3%.The incidence of venous pot coagulation was reduced in the experimental group.3.Safety indicators: During the treatment,the vital signs of patients in the two groups were stable,and there were no complications such as bleeding,alkalosis,hypernatremia,decreased blood pressure,arrhythmia,hypocalcium,etc.;The p H value and residual alkali of the test group were not statistically significant compared with the control group(P >0.05).The difference in arterial calcium ion concentration(ACA)between the experimental group and the control group was statistically significant(P < 0.05),but it was also within the safe range.There was no significant difference in venous calcium ion(VCA)between the two groups(> 0.05).There were no significant changes in FIB,APTT,PT of the venous end of the filter compared with that of the arterial end(P BBB 0 0.05).The anticoagulation of sodium citrate did not affect the coagulation function in vivo.4.Effectiveness indicators: the actual use time of the filter in the test group was longer than that in the control group,the difference was statistically significant(P < 0.05);The average hourly dose of sodium citrate was lower than that in the control group.The average hourly dose of sodium citrate in the experimental group was 271.52 21.47 m L and that in the control group was 295.16 18.09 m L,with statistical significance(P<0.05).The incidence of venous pot coagulation in the test group was 0%.In the control group,there were 8 cases of secondary venous pot clotting,and the incidence of venous pot clotting was 13.3%.The incidence of venous pot coagulation was decreased in the experimental group.TMP and reinfusion pressure in the test group were better than those in the control group during CVVHDF,and the differences between the two groups were statistically significant(P <0.05).There was no significant difference in the clearance of serum creatinine between the experimental group and the control group(P > 0.05),and there was no effect on the clearance of serum creatinine between the experimental group and the control group(P >0.05).Conclusion:1.The application of segmenting citrate anticoagulant in CVVHDF containing calcium replacement solution is safe and effective,which can effectively reduce the dosage of sodium citrate,reduce the clotting rate of venous pot,and prolong the service time of hemofiltration pipeline.It is worthy of clinical promotion.2.The segmenting anticoagulant method of sodium citrate can be safely applied in the hemofiltration of calcium-containing CVVHDF with more than 2L/h replacement fluid,and can avoid the alkalosis and hypernatremia complications caused by segmenting anticoagulant of sodium citrate. |
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