The Clinical Application Of Regional Citrate Anticoagulation In Continuous Renal Replacement Therapy In Children With Liver Insufficiency

Objective:To investigate the safety,efficacy and management strategy of RCA-CRRT in children with liver insufficiency or even acute liver failure.Methods:The clinical data of 75 children with different degrees of liver function damage who received RCA-CRRT in the Department of intensive Care Medicine of the affiliated Children’s Hospital of Chongqing Medical University from January 2015 to October 2019 were analyzed retrospectively.A total of 151 times of CRRT treatment were performed.According to the degree of liver function damage,the patients were divided into two groups: 40 cases in group A(liver failure group)and35 cases in group B(liver insufficiency group).By comparing the occurrence of bleeding/clotting events,citric acid accumulation,acid-base imbalance and electrolyte disturbance between group A and group B,the filter life,changes of blood ammonia,blood lactic acid and creatinine before and after treatment,and the adjustment of parameters of CRRT.To evaluate the efficacy and safety of clinical application of RCA-CRRT in children with liver insufficiency or even liver failure,and then to explore the management strategy of RCA-CRRT.Results: There were 40 cases in group A(79 times of CRRT)and 35 cases of group B(72 times of CRRT).There was no significant difference in age,body weight and sex composition between group A and group B.There was no significant difference in the incidence of bleeding events(5.1% VS 4.2%)and 24-hour filter coagulation events(26.6% VS30.6%)between A and B.The total incidence of citrate accumulation of(CA)and the incidence of persistent CA in group A were significantly higher than those in group B(40.5% VS 15.2%,8.8% VS 1.4%),The incidence of CA in group A and B all decreased significantly through regimen regulation.The incidence of hypocalcemia in group A and B after treatment was significantly lower than that before treatment(11.4% Vs31.6% 1.4% Vs 13.9%),and the incidence of hypocalcemia in group A was significantly higher than that in group B before and after treatment.The incidence of hypercalcemia in group B was slightly higher than that in group A(11.1% Vs 1.4%),but there was no significant difference.After treatment,the incidence of severe acidosis decreased slightly in both groups A and B(5.1 Vs 11.4% Vs 2.8% Vs 5.6%),while the incidence of severe alkalosis increased slightly(6.3% Vs 2.5% Vs 5.6%),but the difference was not statistically significant.There was no significant difference in the incidence of hyponatremia and hyponatremia between group A and group B after treatment.There was no significant difference in the average time of CPB between group A and group B(36.83 ±16.80 h VS 31.94 ±16.92h);After treatment,ALT,AST,creatinine,blood ammonia and lactic acid in group A and B were significantly lower than those before treatment.After adjustment,the blood pump speed and citrate pump speed in group A and B were lower than the initial setting speed,while the dialysis speed + replacement speed was higher than the initial setting speed,but there was no significant difference between group A and B after adjustment.Conclusion: The risk of citrate accumulation in children with liver failure during RCA-CRRT is significantly higher than that in children with liver insufficiency,but RCA-CRRT can still be safely and effectively used in children with liver failure by reasonably adjusting the treatment regimen.