含钙置换液在局部枸橼酸抗凝连续性肾脏替代治疗中的疗效和安全性研究  

Efficacy and safety of calcium-containing replacement solution in continuous renal replacement therapy with regional citrate anticoagulation

作　　者：邱小松 薛婷 叶英 燕宪亮 许铁 Qiu Xiaosong;Xue Ting;Ye Ying;Yan Xianliang;Xu Tie(Xuzhou Medical University Graduate School,Xuzhou 221004,China;Department of Emergency Medicine,the Afiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Jiangsu Provincial Institute of Health Emergency,Xuzhou 221002,China;Department of Emergency Medicine,the Suining People's Hospital,Xuzhou 221200,China)

机构地区：[1]徐州医科大学研究生院,徐州221004 [2]徐州医科大学附属医院急诊医学科,徐州221002 [3]江苏省卫生应急研究所,徐州221002 [4]睢宁县人民医院急诊医学科,徐州221200

出　　处：《国际麻醉学与复苏杂志》2024年第11期1163-1168,共6页International Journal of Anesthesiology and Resuscitation

基　　金：国家重点研发计划项目(2020YFC1512704);江苏省自然科学基金(BK20231162)。

摘　　要：目的比较含钙置换液和无钙置换液在局部枸橼酸抗凝(RCA)连续性肾脏替代治疗(CRRT)中的疗效及安全性。方法选取于徐州医科大学附属医院急诊重症监护病房(EICU)接受RCA的CRRT患者78例, 采用随机数字表法分为含钙置换液组(含钙组, 41例)和无钙置换液组(无钙组, 37例)。两组患者均采用连续性静脉透析滤过后稀释治疗模式, 含钙组使用含钙置换液, 无钙组使用无钙置换液, 两组患者的抗凝方案及葡萄糖酸钙、钾离子补充方式均相同。记录并比较两组患者基线资料[年龄、性别比、病因、急性生理学与慢性健康状况评价Ⅱ(APACHE Ⅱ)、序贯器官衰竭评分(SOFA)及相关实验室检查指标], 血滤器使用寿命、更换血滤器原因, CRRT后1、4、8、16、24、48、72 h血清钙离子浓度及滤器后钙离子浓度, 置管方式、撤机前跨膜压、血流速、置换液流速、透析液流速、治疗剂量、滤过分数、枸橼酸钠使用量及葡萄糖酸钙使用量, 肾功能恢复率、EICU住院时间、28 d病死率及并发症发生率。结果两组患者基线资料差异无统计学意义(均P>0.05)。两组患者血滤器使用寿命、更换血滤器原因差异均无统计学意义(均P>0.05)。含钙组患者葡萄糖酸钙使用量低于无钙组(P<0.05)。两组患者置管方式、撤机前跨膜压、血流速、置换液流速、透析液流速、治疗剂量、滤过分数及枸橼酸钠使用量差异均无统计学意义(均P>0.05)。CRRT后8、24 h无钙组患者血清钙离子浓度高于含钙组(均P<0.05), CRRT后1、4、16、48、72 h两组患者血清钙离子浓度差异均无统计学意义(均P>0.05);CRRT后1、48、72 h含钙组患者滤器后钙离子浓度高于无钙组(均P<0.05), CRRT后4、8、16、24 h两组患者滤器后钙离子浓度差异无统计学意义(均P>0.05)。两组患者肾功能恢复率、EICU住院时间、28 d病死率、并发症发生率差异均无统计学意义(均P>0.05)。结论Objective To compare the efficacy and safety of calcium-containing replacement solution versus calcium-free re-placement solution in continuous renal replacement therapy(CRRT)with regional citrate anticoagulation(RCA).Methods A total of 78 CRRT patients receiving RCA in the emergency intensive care unit(EICU)of the Affiliated Hospital of Xuzhou Medical Universi-ty were selected.According to the random number table method,they were divided into two groups:a calcium-containing replacement solution group(a calcium group,n=41)and a calcium-free replacement solution group(a calcium-free group,n=37).Both groups re-ceived post-dilution continuous veno-venous hemodiafiltration therapy.The calcium group used calcium-containing replacement solu-tion,while the calcium-free group used calcium-free replacement solution.The anticoagulation regimen and methods for calcium gluco-nate and potassium ion supplementation were the same in both groups.Both groups were compared for baseline data:age,gender ratio,etiology,Acute Physiology and Chronic Health Evaluation I(APACHE I)score,Sequential Organ Failure Assessment(SOFA)score,and relevant laboratory indicators.The lifespan of hemofilters and reasons for their replacement were recorded.Serum calcium ion concentrations and post-filter calcium ion concentrations were measured at post-CRTT 1,4,8,16,24,48 h,and 72 h.Both groups were compared for catheterization methods,transmembrane pressure before machine withdrawal,blood flow rate,replacement fluid flow rate,dialysate flow rate,treatment dose,filtration fraction,sodium citrate dosage,and calcium gluconate dosage.Their renal function recovery rate,the length of EICU stay,28-day mortality rate,and incidence of complications were also recorded.Results There were no statistical differences in baseline data between the two groups(all P>0.05).The lifespan of hemofilters and reasons for their replacement did not differ significantly(all P>0.05).The calcium group had a significantly lower dosage of calcium gluconate compared with the calcium-

关 键 词：含钙置换液 连续性肾脏替代治疗 局部枸橼酸抗凝 

分 类 号：R692.5[医药卫生—泌尿科学]