枸橼酸局部抗凝持续肾脏替代的代谢性碱中毒——一项单中心回顾性研究  

Metabolic alkalosis induced by regional citrate anticoagulation in continuous renal replacement therapy:A single-center retrospective study

作　　者：唐晗琪 崔庆宏 石靖 朱华栋 于学忠 徐胜勇 徐军 Tang Hanqi;Cui Qinghong;Shi Jing;Zhu Huadong;Yu Xuezhong;Xu Shengyong;Xu Jun(Address:Emergency Department,The State Key Laboratory for Complex,Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing,100730 China)

机构地区：[1]中国医学科学院北京协和医学院,北京协和医院急诊科,疑难重症及罕见病国家重点实验室,北京100730

出　　处：《中华急诊医学杂志》2025年第2期220-225,共6页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金数学天元基金项目(12126604)。

摘　　要：目的持续肾脏替代治疗(renal replacement therapy,CRRT)中应用枸橼酸抗凝时出现代谢性碱中毒值得关注,研究旨在探索代谢性碱中毒发生的危险因素及可能机制。方法采用单中心回顾性研究方法,选择2017年4月至2020年4月在北京协和医院急诊科接受枸橼酸抗凝的CRRT治疗至少12 h的患者,记录患者的流行病学数据、基线化验指标、CRRT相关治疗参数、治疗12 h的化验参数。根据患者治疗过程是否使用碳酸氢钠、治疗12 h后有无代谢性碱中毒将患者分为4组,采用多因素二元回归分析,筛选枸橼酸抗凝CRRT治疗时发生代谢性碱中毒的危险因素。结果纳入分析的59例患者中男性患者占比49%,的年龄为(55±18)岁,其中42%患者在CRRT进行12 h后出现了代谢性碱中毒。根据患者是否接受碳酸氢钠及CRRT12 h后是否出现代谢性碱中毒将患者分为4组,各组流行病学数据和基线实验室数据差异无统计学意义。各组间的CRRT参数包括血流速、枸橼酸流速、置换液流速及废液流速差异有统计学意义(P<0.01)。多因素回归分析表明枸橼酸流速是代谢性碱中毒的危险因素(OR=1.088,95%CI 1.020~1.161,P=0.010)。未接受碳酸氢钠且未出现代谢性碱中毒的患者组中,线性回归分析表明该组患者中枸橼酸流速和置换液流速存在一定线性相关(枸橼酸流速=0.090×置换液流速+56.581;R^(2)=0.6918),枸橼酸流速和废液流速存在线性关系(枸橼酸流速=0.099×废液流速+2.449;R^(2)=0.9528)。结论枸橼酸抗凝的CRRT中参数设置与CRRT 12 h后代谢性碱中毒相关。在未应用碳酸氢钠且未发生代谢性碱中毒的患者中,观察到枸橼酸流速和废液流速存在一个1:10的线性关系。Objective Metabolic alkalosis has raised concerns in patients receiving continuous renal replacement therapy(CRRT)via regional citrate anticoagulation(RCA).This study searched for alkalosis-related factors and mechanisms.Methods It's a retrospective study of alkalosis in patients who received CRRT for at least 12 hours with RCA in a tertiary hospital between April 2017 and April 2020.Demographic features,baseline laboratory results,CRRT metrics and laboratory results at 12h after CRRT was recorded.Patients was grouped based on whether alkalosis exist at 12h after CRRT,and multivariable logistic regression analysis was used to identify risk factors for alkalosis during CRRT with citrate anticoagulation.Results The 59 patients meeting the inclusion criteria were 49%male,with a mean age of(55±18)years old,and 42%had alkalosis by 12 hours after CRRT.No significant differences in demographic features or laboratory results were observed patients with or without alkalosis.CRRT metrics,including blood flow rate,citrate rate,replacement fluid rate and total effluent rate,were significantly different among groups(P<0.01).Multivariable Logistic regression analysis indicated that the citrate rate was a risk factor for alkalosis(OR=1.088,95%CI 1.020-1.161,P=0.010).In patients receiving no NaHCO3 and without alkalosis,the linear regression analysis described the relationships of citrate with replacement fluid rate(citrate rate=0.090×replacement fluid rate+56.581;R^(2)=0.6918)and total effl uent rate(citrate rate=0.099×total effluent rate+2.449).Conclusions This retrospective observational study demonstrated that CRRT metrics are highly associated with alkalosis after 12 hours of CRRT.Without NaHCO3 infusion,a 10-fold linear correlation was observed between citrate and total effl uent rate in patients without metabolic alkalosis.Fund program:National Natural Science Foundation of China“Mathematical Tianyuan Program”(12126604)

关 键 词：持续肾脏替代治疗 枸橼酸 抗凝 代谢性碱中毒 肾功能不全 危险因素 队列研究 机制 

分 类 号：R459.7[医药卫生—急诊医学]