The Comparative Study Of Heparin Versus Citrate Anticoagulation For Continuous Renal Replacement Therapy Rewarming In Hypothermia Dogs With Seawater Immersion

Objective 1 Established the model of dogs with abdominal injury and seawater immersion induced to accidental hypothermia;2 To study the effect of systemic heparin anticoagulation or regional citrate anticoagulation during continuous renal replacement therapy rewarming on acidosis,electrolytes and coagulation dysfunction of accidental hypothermia dogs;3 To study the effect of systemic heparin anticoagulation or regional citrate anticoagulation during continuous renal replacement therapy rewarming on ALT,TBIL,SCr,BUN,CI and MAP of accidental hypothermia dogs.Methods 1 Animal models established: 19 adult beagle dogs,anesthetized and placed the catheters then producted a 6-8cm incision below the xiphoid(about 3cm).Then placed the dogs in a pre-prepared low-temperature seawater,soaked plane up to 3-4cm of the xiphoid,when the temperature dropped to 28 ? the models were completed.2 Experimental grouping: according to the rewarming method,they were randomly divided into 3 groups.A group:warm water bath combined with continuous renal replacement therapy rewarming,during the process of CRRT systemic heparin anticoagulation were used(heparin anticoagulant group,n = 7).B group: warm water bath combined with continuous renal replacement therapy rewarming,during the process of CRRT regional citrate anticoagulation were used(citrate anticoagulation group,n = 7).C group warm water bath rewarming(control group,n = 5).3 Detected indicators: blood coagulation,arterial blood gas,blood routine,blood biochemistry and hemodynamics were measured at normal body temperature,body temperature dropped to 34 ?,rewarming to 30 ?,rewarming to 34 ? and rewarming to 38 ?.At the same time,the mortality of each group was observed.Results 1 The mortality rate of three groups:14%(1/7)of heparin anticoagulation group,0%(0/7)of citrate anticoagulation group,40%(2/5)of control group.2 Improved of acidosis:when rewarming to 38 ?,the HCO3-of heparin anticoagulation group and citrate anticoagulation group were significantly higher than the control group,the difference were statistically significant(P <0.05);when rewarming to 38 ?,the PH of heparin anticoagulation group and citrate anticoagulation group were higher than control group,but the difference were not statistically significant(P> 0.05).3 Improved of coagulation: when rewarming to 34 ? and 38 ?,APTT in heparin anticoagulation group were significantly higher than that in citrate anticoagulant group and control group,the difference were statistically significant(P <0.05);when rewarming to 38 ?,platelet in heparin anticoagulation group were significantly lower than that in citrate anticoagulant group and control group,the difference were statistically significant(P <0.05);there were no significant difference in PT,FIB and INR among the three groups at each time point(P> 0.05).4 Improved of the electrolyte: when rewarming to 30 ?,34 ? and 38 ?,the serum calciumion in citrate anticoagulant group were significantly higher than that in heparin anticoagulant group and control group,the difference were statistically significant(P <0.05);when rewarming to 34 ? and 38 ?,the serum sodium in citrate anticoagulant group were higher than that in heparin anticoagulant group and control group,but the difference were not statistically significant(P> 0.05);there were no significant difference in serum potassium between the three groups at each time point(P> 0.05).5 The effect on ALT and TBIL: there were no significant difference in ALT and TBIL among the three groups at each time point(P> 0.05).6 The effect on SCr and BUN:when rewarming to 34 ? and 38 ?,the SCr and BUN in control group were higher than citrate anticoagulant group and heparin anticoagulant group,the difference were statistically significant(P <0.05).7 The effect on CI and MAP: when rewarming to 30 ?,34 ? and 38 ?,the CI and MAP of the control group were lower than those of heparin anticoagulant group and citrate anticoagulation group,but the difference were not statistically significant(P> 0.05).Conclusions 1 There were no differences on correcting acidosis of accidental hypothermia dogs,between regional citrate anticoagulation and systemic heparin anticoagulation during the process of continuous renal replacement therapy rewarming.2 Regional citrate anticoagulation will be better than systemic heparin anticoagulation on correcting coagulation of accidental hypothermia dogs,during the process of continuous renal replacement therapy rewarming.3 Regional citrate anticoagulation will be better than systemic heparin anticoagulation on correcting hypocalcemia of accidental hypothermia dogs,by controlling the infusion rate of citrate and calcium chloride during the process of continuous renal replacement therapy rewarming.4 The effects on serum sodium,serum potassium,ALT,TBIL,SCr,BUN,CI and MAP of accidental hypothermia dogs,between regional citrate anticoagulation and systemic heparin anticoagulation during the process of continuous renal replacement therapy rewarming hadno differences.