局部枸橼酸抗凝在脓毒症合并高乳酸血症患者连续性肾脏替代治疗中的应用  

Application of regional citrate anticoagulation in continuous renal replacement therapy for patients with sepsis and hyperlactacidemia

作　　者：郑燚 王瑶 代礼 王芳 陈志文 张凌[2] 王艳艳 ZHENG Yi;WANG Yao;DAI Li;WANG Fang;CHEN Zhiwen;ZHANG Ling;WANG Yanyan(Department of Nephrology,West China Hospital,Sichuan University/West China School of Nursing,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Nephrology and Institute of Kidney Diseases,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;West China School of Nursing,Sichuan University/Healthcare Innovation Research Laboratory,West China Hospital,Sichuan University/Nursing Key Laboratory of Sichuan Province,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院肾脏内科/四川大学华西护理学院,成都610041 [2]四川大学华西医院肾脏内科/肾脏病研究所,成都610041 [3]四川大学华西护理学院/四川大学华西医院护理创新研究室/护理学四川省重点实验室,成都610041

出　　处：《华西医学》2024年第7期1075-1081,共7页West China Medical Journal

摘　　要：目的探索局部枸橼酸抗凝(regional citrate anticoagulation,RCA)在脓毒症合并高乳酸血症患者连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)中的应用情况,为此类患者的RCA临床应用提供依据。方法回顾性纳入2021年5月-2023年5月在四川大学华西医院行RCA-CRRT的脓毒症患者。根据CRRT开始前初始乳酸水平将患者分为乳酸正常组(≤2.0 mmol/L)和高乳酸血症组(>2.0 mmol/L),并对中度高乳酸血症(2 mmol/L0.05)。乳酸正常组与高乳酸血症组的枸橼酸蓄积发生率分别为13.0%和25.9%(P<0.05)。两组的代谢性酸中毒、代谢性碱中毒、高钠血症、滤器凝血事件发生率以及住院期间死亡比例差异均无统计学意义(P>0.05)。Kaplan-Meier生存分析显示,乳酸正常组与高乳酸血症组首个体外循环寿命差异无统计学意义(P>0.05)。213例高乳酸血症患者中,中度高乳酸血症186例,重度高乳酸血症27例。PSM前,中度与重度高乳酸血症组的男性比例、糖尿病比例、白蛋白水平、国际标准化比值、白细胞介素-6差异均有统计学意义(P<0.05)。PSM后,中度与重度高乳酸血症组均为22例患者。两组患者的基线特征差异均无统计学意义(P>0.05)。中度高乳酸血症组与重度高乳酸血症组的枸橼酸蓄积发生率分别为18.2%和50.0%(P<0.05)。两组的代谢性酸中毒、代谢性碱中毒、高钠血症、滤器凝血事件发生率以及住院期间死亡比例差异均无统计学意义(P>0.05)。Kaplan-Meier生存分析显示,中度高乳酸血症组与重度高乳酸血症组首个体外循环寿命差异无统计学意义(P>0.05)。结论RCA用于脓毒症伴高乳酸血症患者的CRRT抗凝时,枸橼酸蓄积发生率较高(尤其是重度高乳酸血症患者),应严密监测。Objective To explore the application of regional citrate anticoagulation(RCA)in continuous renal replacement therapy(CRRT)for patients with sepsis and hyperlactacidemia,and to provide a basis for the clinical application of RCA in such patients.Methods Sepsis patients who underwent RCA-CRRT at West China Hospital of Sichuan University between May 2021 and May 2023 were retrospectively included.Patients were divided into a normal lactate group(≤2.0 mmol/L)and a hyperlactacidemia group(>2.0 mmol/L)based on their initial lactate levels before CRRT,and subgroup analysis was performed on patients with moderate hyperlactacidemia(2 mmol/L<lactate level<4 mmol/L)and severe hyperlactacidemia(≥4.0 mmol/L).Propensity score matching(PSM)was used,and baseline characteristics and outcome measures of different groups of patients were compared.ResultsA total of 441 patients were included,with 228 in the normal lactate group and 213 in the hyperlactacidemia group.Before PSM,there were statistically significant differences in the proportion of liver failure,proportion of chronic kidney disease,mean arterial pressure,bicarbonate,total bilirubin,creatinine,activated partial thromboplastin time,international standardized ratio,procalcitonin,and interleukin-6 between the normal lactate group and the hyperlactacidemia group(P<0.05).After PSM,there were 162 patients in both the normal lactate group and the hyperlactacidemia group.There was no statistically significant difference in baseline characteristics between the two groups of patients(P>0.05).The incidence of citric acid accumulation in the normal lactate group and the hyperlactacidemia group was 13.0%and 25.9%,respectively(P<0.05).There was no statistically significant difference in the incidence of metabolic acidosis,metabolic alkalosis,hypernatremia,filter coagulation events,or in-hospital mortality between the two groups(P>0.05).Kaplan-Meier survival analysis showed that there was no statistically significant difference in the first extracorporeal circulation lifespan betw

关 键 词：脓毒症 高乳酸血症 连续性肾脏替代治疗 局部枸橼酸抗凝 

分 类 号：R459.7[医药卫生—急诊医学]