滤器后离子钙浓度对应用局部枸橼酸抗凝进行连续性肾脏替代治疗体外循环寿命的影响  

Influence of post-filter ionic calcium gradients on the longevity of CRRT local citrate anticoagulation in extracorporeal circulation

作　　者：王宝栋 唐前容 Niroj Mali 潘红菊 张凌[1] Wang Baodong;Tang Qianrong;Niroj Mali;Pan Hongju;Zhang Ling(Department of Nephrology,West China Hospital,Sichuan University,Chengdu610041,China;Department of Nephrology,Shanxi Provincial People′s Hospital,the Fifth Clinical Medical College of Shanxi Medical University,Taiyuan030012,China;Department of Nephrology,Second People′s Hospital of Yibin,Yibin644000,China;Department of Nephrology,Linfen Central Hospital,Linfen041000,China)

机构地区：[1]四川大学华西医院肾脏内科、四川大学华西医院肾脏病研究所,成都610041 [2]山西省人民医院、山西医科大学第五临床医学院肾脏内科,太原030012 [3]宜宾市第二人民医院肾脏内科,宜宾644000 [4]山西省临汾市中心医院肾脏内科,临汾041000

出　　处：《中华医学杂志》2024年第44期4081-4086,共6页National Medical Journal of China

基　　金：国家重点研发计划(2023YFC2411800)。

摘　　要：目的探讨不同滤器后离子钙(Ca^(2+))浓度(0.25~0.35 mmol/L和>0.35~0.50 mmol/L)对应用局部枸橼酸抗凝(RCA)进行连续性肾脏替代治疗(CRRT)体外循环寿命的影响。方法回顾性分析四川大学华西医院2021年3月至2022年6月应用RCA进行CRRT的患者资料,收集患者的基本信息及治疗开始后0、2、6 h及后续每6小时滤器后Ca^(2+)浓度值,按每次治疗Ca^(2+)浓度均值分为低浓度组(0.25~0.35 mmol/L)和高浓度组(>0.35~0.50 mmol/L),并通过1∶1进行倾向性评分匹配,评价不同滤器后Ca^(2+)浓度对体外循环寿命的影响。结果共纳入患者232例,男147例,女85例,年龄(58.2±16.9)岁。CRRT治疗431例次,共12592 h,其中低浓度组317例次(73.5%),高浓度组114例次(26.5%)。将两组基线资料1∶1匹配后,每组纳入113例次进行分析。低浓度组和高浓度组凝血事件发生率分别为54.9%(62/113)和54.0%(61/113)(P=0.894);体外循环寿命[M(Q_(1),Q_(3))]分别为65.0(29.0,72.0)h和68.0(31.5,72.0)h(P=0.805),差异均无统计学意义(均P>0.05);多因素Cox回归分析结果显示,滤器后Ca^(2+)浓度对体外循环寿命无明显影响(HR=0.99,95%CI:0.55~1.79)。结论在应用RCA进行CRRT过程中,滤器后Ca^(2+)浓度目标值适当放宽至0.25~0.50 mmol/L,仍可能达到合格的抗凝。ObjectiveTo investigate the influence of different post-filter ionic calcium(Ca^(2+))gradients(0.25-0.35 mmol/L vs>0.35-0.50 mmol/L)on the extracorporeal lifetime of local citrate anticoagulation(RCA)for continuous renal replacement therapy(CRRT).MethodsPatients who underwent CRRT with RCA at West China Hospital of Sichuan University from March 2021 to June 2022 were retrospectively selected.The basic information and the values of post-filter Ca^(2+)at 0,2,and 6 hours after the start of treatment and every 6 hours thereafter were collected.The patients were divided into low concentration group(0.25-0.35 mmol/L mmol/L)and high concentration group(>0.35-0.50 mmol/L)according to the mean value of Ca^(2+)concentration per treatment,and propensity score matching was performed in a 1∶1 ratio to evaluate the effect of post-filter[iCa^(2+)]on the duration of extracorporeal circulation in different groups.ResultsA total of 232 patients(147 males and 85 females)aged(58.2±16.9)years were enrolled.There were 431 cases treated with CRRT for 12592 h,including 317 cases(73.5%)in the low concentration group and 114 cases(26.5%)in the high concentration group.The baseline data of the two groups were matched and analyzed.Coagulation events occurred in 54.9%(62/113)and 54.0%(61/113)in the low and high concentration groups,respectively(P=0.894).The median survival on extracorporeal circulation was 65.0(29.0,72.0)h and 68.0(31.5,72.0)h in the two groups,respectively(P=0.805).Multivariate Cox regression analyses showed that post-filter[iCa^(2+)]had no effect on extracorporeal life expectancy(HR=0.99,95%CI:0.55-1.79).ConclusionDuring CRRT treatment with RCA,the desired anticoagulant effect can still be achieved when the post-filter[iCa^(2+)]target was set to 0.25-0.50 mmol/L.

关 键 词：连续性肾脏替代治疗 局部枸橼酸抗凝 体外循环寿命 滤器后离子钙 

分 类 号：R459.5[医药卫生—治疗学]