局部枸橼酸抗凝在伴有肝功能障碍的连续性肾脏替代治疗患者中的应用  

Application of Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy of Patients with Liver Dysfunction

作　　者：高孝朋 臧彬[1] GAO Xiaopeng;ZANG Bin(Department of Intensive Care Unit,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院重症医学科

出　　处：《医学综述》2019年第24期4928-4932,4945+4942-4944+4946,共5页Medical Recapitulate

摘　　要：连续性肾脏替代治疗(CRRT)是重症监护病房常用的器官支持手段之一,而抗凝是CRRT顺利进行的关键。与普通肝素、低分子肝素及无肝素抗凝相比,局部枸橼酸抗凝具有出血风险小、滤器寿命长等显著优势,但对于肝功能减退患者,由于代谢能力的下降,体内枸橼酸清除能力降低,可能发生枸橼酸蓄积、低钙等并发症故限制了其使用。近年来,局部枸橼酸抗凝在肝功能不同程度减退患者中得到广泛使用,滤器寿命远超普通肝素抗凝或无肝素抗凝,且没有严重的枸橼酸蓄积、低钙、碱中毒等不良后果发生。但目前有关枸橼酸在不同程度肝功能障碍患者中的具体使用剂量、补钙方案及监测方案仍无明确的推荐意见,未来需进一步研究。Continuous renal replacement therapy(CRRT)is one of the most commonly used organ support methods in intensive care unit,and anticoagulation is the key to successful CRRT.Compared with unfractionated heparin,low molecular weight heparin and heparin-free anticoagulation,regional citrate anticoagulation has significant advantages,such as low risk of bleeding and long filter life.However,in patients with hypohepatic function,citrate clearance ability in vivo decreases due to the decline of metabolic capacity,and citrate accumulation,low calcium and other complications may limit its use.In recent years,local citric acid anticoagulation has been widely used in patients with different degrees of liver dysfunction.The life span of filter is much longer than that of ordinary heparin anticoagulation or non-heparin anticoagulation,and there are no serious adverse consequences such as citric acid accumulation,low calcium,alkalosis,etc.However,there are still no definite recommendations on the specific dosage of citric acid in patients with different degrees of liver dysfunction,calcium supplementation scheme and monitoring scheme,and further research is needed in the future.

关 键 词：肝功能障碍 连续性肾脏替代治疗 局部枸橼酸抗凝 

分 类 号：R459.5[医药卫生—治疗学]