The Apllication Research Of Local Citrate Anticoagulation With Continuous Renal Replacement Therapy In Children

Backgrand:Continuous renalreplacementtherapy?CRRT?is an importantlife-saving treatment in the therapeutic areas of critically ill patient,which can remove water and solute numerator in the blood slowly and replace organ function.The safe and effective anticoagulation is an important guarantee for the smooth progress of CRRT,The process is easytocomplicate with coagulationdysfunction,clottingfactor consumption and bleeding for children with low blood capacity and high infectionfactors.Heparin anticoagulation is often used in clinical CRRT,and local citrate anticoagulation has been introduced into clinical practice with the characteristics of anticoagulation and low risk of bleeding.in recent years.Objctive:The study aims to explore the safety and efficacy of local citrate anticoagulation and provide a theoretical basis for the selection of anticoagulation therapy for children^'sCRRT?Methods:Critically ill children with CRRT are studied on respectively in the Children's medical centre of Hunan provincial people's hospital from October 2013 to December 2016,the demographics,general clinical data and relevant parameters before and after CRRT were collected and analyzed.The children enrolled in this study have all chosen central venous double lumen catheter?femoral vein or internal jugular vein?and used different types of hemodiafiltration tube and filters according to different age and weight,All the pipeline and filter used during CRRT were flushed with heparinised normal saline?30mg:3000ml?and then uesd plasma for preflush.Connected into xuhuacheng IQ21 blood purification machine and blood filter double lumen.They were all used continuous veno-venous hemofiltration?CVVH?mode,set the blood pump speed of 3-5ml/kg.min,fluid infusion pump speed of35-50 ml/kg.h,and dehydration speed of 2-5 ml/kg.h.The substitution fluid is the general formula of intensive care unit in Children medical center of Hunan provincial people's hospital.The anticoagulation methods in patients with CRRT were divided into citrate group and heparin group according to the inclusion and exclusion criteria.The changes of relative parameters before and after CRRT were compared in citrate group.The admission time,prognosis,PCIS?Pediatric Critical Illness Score?,hematological indexes before and after CRRT,coagulation indexes,kidney function,blood gas indexes and the filter lifespans were monitored,and the efficacy and safety of anticoagulation were evaluated.Results:In this study,50 cases of critically ill children were treated with crrt,including 35 cases of citricate group and 15 cases of heparin group,Before the CRRT,there was noobvious statistical significance in gender,ages,weights and PCIS of the two groups?P>0.05?.Before the CRRT,a comparison of white blood cells?WBC?,hemoglobin?HB?,platelet count?PLT?,coagulation functions,renal functions and blood gas indexes between the two groups were made,and there was no obvious statistical significance?P>0.05?.There were no significant changes in APTT,PT before and after the treatment in Citrate group,while the APTT and PT are prolonged after the treatment than before in Heparin group?P<0.05?.There was no obvious statistical significance in blood gas indexes before and after the treatment between two groupsP>0.05).There were no statistical significance in Ca²⁺before the filter,The duraion of CRRT?medianquartile interval?wererespectively16?8,24?h and 6.25?6,11.1?h in citrate and heparin group,which proved that the duraion of CRRT of citrate group was longer than that of heparin group.The BUN and Cr of both group were significantly decreased after CRRT?P<0.05?.The WBC and Hb were lower after the treatment in Citrate group?P<0.05?,and the same with Hb and PLT in heparin group after the treatment?P<0.05?.Conclusion1.Sodium citrate has clinical effective,safe and less adverse reactions in the use of anticoagulation during CRRT.2.The duraion of CRRT of citrate group is obviously longer than that of heparin group,and the efficacy is superior to heparin.3.CRRT can reduce the level of blood urea nitrogen and creatinine,improve renal function and pediatric critical illness score.