Application Value Of Regional Citrate Anticoagulation In Continuous Renal Replacement Therapy In Patients With Lactic Acidosis

BackgroundLactic acidosis is one of the common critical diseases in clinical practice.Usually,the increase of lactic acid concentration means poor prognosis and increased mortality.In the treatment,in addition to removing the inducement,stabilizing the inner ring outside,rapidly reducing lactic acid,and actively correcting the primary disease are the keys to the success of the treatment.Therefore,using continuous renal replacement therapy（CRRT）as early as possible is of great importance to save patients’lives.During the treatment of CRRT,anticoagulation is a necessary condition to ensure the smooth operation of CRRT.It is found that regional citrate anticoagulation（RCA）can achieve in vitro anticoagulation without affecting the whole blood coagulation system,and can also be metabolized into hydrogen carbonate in the body,which plays a certain acid-base buffering role,making it more and more widely used in clinical practice.ObjectiveTo retrospectively study the efficacy and safety of continuous venous venous hemofiltration（CVVH）in patients with lactic acidosis induced by citrate anticoagulation and low molecular weight heparin,aiming to investigate the safety and efficacy of RCA in patients with lactic acidosis.MethodsRetrospective analysis of clinical data of 55 patients with lactic acidosis who were admitted to CVVH in Nanyang Central Hospital from May 2017 to July 1818.The observation group was treated with local citrate anticoagulation,and the control group was treated with low molecular weight heparin.Of these,42 received anticoagulation with citrate and 13 received anticoagulation with low molecular weight heparin.The White blood cells（WBC）,platelet（PLT）,electrolyte(Ca²⁺),activated partial thromboplastin time（APTT）,serum creatinine（Scr）,blood urea nitrogen（BUN）and CRRT were measured before and after treatment for 8h,12h,24h,48h before and after treatment.Changes in blood gas analysis(pH,Lac,HCO₃^-,BE,Na⁺,Ca²⁺)levels were recorded and filter life was recorded.Results1.Among 55 patients with lactic acidosis,29 males（52.7%）and 26 females（47.3%）;42 patients in the observation group,22 males and 20 females,with an average age of（60.36±14.78）years;There were 13 patients in the control group,including 7 males and 6females with an average age of（61.15±16.45）years.Before the CRRT treatment,there was no significant difference in gender,age,APACHE-II score and primary disease between the two groups（P>0.05）.2.The pH value of Lac and 8h in the observation group was significantly lower than that in the control group at 8h after treatment（P<0.05）.There was no significant difference in pH,Lac,HCO₃^-,BE,Na⁺,Ca²⁺between the two groups（P>0.05）.3.The average life span of the filter and the coagulation of extracorporeal circulation in the two groups were compared.There was no serious extracorporeal circulation coagulation in the observation group,and all the treatments were successfully completed.There were 4 cases of grade II or III filter coagulation events in the control group,and 3cases of pulmonary coagulation events.The life of the filter was observed in the observation group（13.82±7.9）h;the life of the filter in the control group was（9.56±4.35）h.The life of the filter in the observation group was significantly longer than that in the control group,and the difference was statistically significant（P<0.05）.4.Compared with the control group,the platelet counts of the two groups were significantly lower than those of the control group,and were significantly lower than the observation group.The difference was statistically significant（P<0.05）.The APTT of the control group was prolonged compared with the time before treatment.The difference was statistically significant（P<0.05）.The WBC treatment was significantly lower than that before treatment（P<0.05）.There was no significant difference between the two groups（P>0.05）.5.Blood purification effect:blood urea nitrogen（BUN）,creatinine（Cr）after treatment of CRRT in the two groups,the difference was statistically significant（P<0.05）;blood urea nitrogen（BUN）,creatinine（Cr）between the two groups The changes were compared and the difference was not statistically significant（P>0.05）.Conclusion1.Compared with the control group,the service life of the filter in the observation group was significantly longer than that in the control group,which was more advantageous in clinical practice.In the observation group,the effect of reducing lactic acid in a short time was obvious,and the acidosis was corrected.The low incidence of extracorporeal circulation coagulation does not affect the blood coagulation system,reducing the risk of bleeding.2.Comparison of clinical indicators after treatment in both groups,both of which can effectively remove creatinine,urea nitrogen and other substances in the body,and can maintain stable water,electrolyte and acid-base balance.