局部枸橼酸抗凝在接受连续性肾脏替代治疗的肝病合并急性肾损伤中的应用效果观察  

Efficacy and safety of regional citrate anticoagulation in patients with severe liver diseases and acute kidney injury receiving continuals renal replacement therapy

作　　者：宁琪琪 高原[1] 段美丽[2] 刘海霞[1] 孟庆华[1] 于红卫[1] 胡中杰[1] 朱跃科[1] NING Qiqi;GAO Yuan;DUAN Meili(Department of Severe Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China)

机构地区：[1]首都医科大学附属北京佑安医院肝病重症医学科,北京100069 [2]首都医科大学附属北京友谊医院重症医学科,北京100054

出　　处：《临床肝胆病杂志》2020年第5期1055-1058,共4页Journal of Clinical Hepatology

基　　金：国家科技重大专项(2018ZX10302-206-003-007);北京市丰台区卫生计生系统科学研究项目(2017-60)。

摘　　要：目的探讨在接受连续性肾脏替代治疗(CRRT)的严重肝病合并急性肾损伤(AKI)患者中应用滤器局部枸橼酸抗凝(RCA)的有效性及安全性。方法回顾性收集2016年1月-2019年3月于首都医科大学附属北京佑安医院和首都医科大学附属北京友谊医院行RCA-CRRT的175例肝病合并AKI患者(肝病组)和285例非肝病合并AKI患者(非肝病组)的住院病历资料以及首次CRRT记录资料。观察并比较患者治疗前后肝肾功能生化指标、血气分析、乳酸、钙离子(iCa2+)和总钙(tCa2+)的变化、滤器平均运行寿命、不良反应等。符合正态分布的计量资料组内比较采用配对t检验,两组间比较采用独立样本t检验;不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ2检验。采用Kaplan-Meier生存曲线分析两组间的滤器运行寿命并应用log-rank检验进行比较。结果CRRT前,肝病组患者ALT、AST、TBil、BUN水平均显著高于非肝病组(P值均<0.05)。肝病组和非肝病组患者经治疗后,iCa2+、tCa2+、碱剩余均基本纠治正常,治疗前后组内比较差异均有统计学意义(P值均<0.05)。肝病组治疗结束时枸橼酸蓄积(tCa2+/iCa2+>2.5)的发生率明显高于非肝病组(12.0%vs 2.2%,χ2=18.65,P<0.001)。肝病组和非肝病组患者平均滤器运行寿命比较,差异无统计学意义[(32.20±24.99)h vs(32.96±18.93)h,t=0.346,P>0.05];两组滤器48 h生存率比较,差异亦无统计学意义(28.1%vs 26.9%,χ2=1.356,P=0.381)。治疗期间两组均无明显枸橼酸蓄积相关不良反应发生。结论在严重肝病患者进行CRRT时应用RCA,枸橼酸蓄积发生率虽较高,但抗凝效果理想,且较为安全。Objective To investigate the efficacy and safety of regional citrate anticoagulation(RCA)in patients with severe liver diseases and acute kidney injury(AKI)receiving continuous renal replacement therapy(CRRT).Methods A retrospective analysis was performed for the medical records and first-time CRRT data of 175 liver disease patients with AKI(liver disease group)and 285 non-liver disease patients with AKI(non-liver disease group)who underwent RCA-CRRT in Beijing You’an Hospital and Beijing Friendship Hospital,Capital Medical University,from January 2016 to March 2019.The two groups were compared in terms of the changes in hepatic and renal function markers,blood gas parameters,lactic acid,ionized calcium(iCa2+),and total calcium(tCa2+)after treatment,as well as the mean operation life of filter and adverse reactions.The paired t-test or the independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.The Kaplan-Meier survival curve was used to analyze the operation life of filter in the two groups,and the log-rank test was used for comparison.Results Before CRRT,the level of ALT、AST、TBil、BUN in liver disease group were significantly higher than those in non-liver disease group(all P<0.05).After treatment,iCa2+,tCa2+,pH value,and base excess basically returned to normal,and there were significant differences in the same group before and after treatment(all P<0.05).Compared with the non-liver disease group,the liver disease group had a significantly higher incidence rate of citrate accumulation(tCa2+/iCa2+>2.5)during treatment(12%vs 2.2%,χ2=18.65,P<0.001).There was no significant difference in the mean operation life of filter between the liver disease group and the non-liver disease group(32.20±24.99 h vs 32.96±18.93 h,t=0.346,P>0.05)and there was also no signif

关 键 词：肝疾病 急性肾损伤 肾替代疗法 柠檬酸盐类 

分 类 号：R575[医药卫生—消化系统]