局部枸橼酸抗凝在连续肾脏替代疗法串联人工肝治疗中的运用效果观察

doi:10.3969/j.issn.1006-5725.2024.13.020

Abstract

Abstract:

Objective To observe the effectiveness and safety of Regional Citrate Anticoagulation （RCA） in CRRT combined with artificial liver treatment. Methods Clinical data of 54 sessions of CRRT linked with artificial liver treatment using RCA in 21 patients with acute on chronic liver failure （ACLF） combined with acute kidney injury （AKI） admitted to our center from December 2019 to June 2023 were collected.. The improvement of liver and kidney function indicators， anticoagulant effect and adverse reactions of citric acid， and patient outcomes were observed and analyzed before and after treatment. Results The 54 cases of liver and renal function indexes were improved， which showed a statistically significant difference （P < 0.05）； All 54 cases of CRRT linked artificial liver treatment were successfully completed， and no obvious blood clots were found in the extracorporeal circulation tubing， filters， and adsorbers； There was no statistically significant difference （P > 0.05） in the total calcium and ionized calcium levels of all patients at each stage of artificial liver treatment compared to before treatment； However， three cases of CRRT combined with PE and one case of CRRT combined with DPMAS+LPE experienced citrate accumulation after treatment， which returned to normal after 24 hours of timely correction and supplementation； The 30-day survival rate of the 21 patients was 13 survivors， 5 deaths， and 3 discharged automatically. Conclusion Under strict monitoring and timely adjustment， the application of RCA in CRRT series artificial liver treatment is safe and feasible， and is worthy of clinical promotion.

Key words: acute on chronic liver failure, acute kidney injury, citric acid, artificial liver, CRRT

CLC Number:

R734.2

Yufeng JIN,Cunyi SHEN,Jingyao ZHANG,Yulong XUE,Dong. HE. Observation on the application effect of local citrate anticoagulation in CRRT tandem artificial liver treatment[J]. The Journal of Practical Medicine, 2024, 40(13): 1879-1884.

Figures/Tables 4

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Tab.3

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检验指标	治疗前	治疗后与治疗前比下降率（%）	治疗后24 h与治疗前比下降率（%）
凝血酶原活度（%）	37.76 ± 8.19	6.76 ± 25.22	-0.16 ± 15.72
活化部分凝血活酶时间（s）	34.36 ± 7.45	15.96 ± 10.11 ^*	4.24 ± 8.40
TBIL（μmol/L）	381.97 ± 56.38	34.34 ± 5.16 ^*	11.69 ± 4.83^*
直接胆红素（μmol/L）	232.45 ± 55.27	21.86 ± 11.16 ^*	5.00 ± 11.36^*
间接胆红素（μmol/L）	147.10 ± 38.98	47.21 ± 15.09 ^*	28.34 ± 24.33^*
肌酐（μmol/L）	342.66 ± 85.16	10.62 ± 4.35	40.86 ± 10.93^*
尿素氮（mmol/L）	44.59 ± 9.62	4.45 ± 1.24	20.17 ± 7.12^*
MELD评分	24.79 ± 2.51	23.59 ± 4.42 ^*	12.97 ± 5.38^*

检验指标	治疗前	治疗后与治疗前比下降率（%）	治疗后24 h与治疗前比下降率（%）
凝血酶原活度（%）	36.62 ± 7.84	-11.07 ± 20.41	-2.48 ± 14.30
活化部分凝血活酶时间（s）	35.62 ± 8.54	15.83 ± 13.30^*	3.97 ± 8.80
TBIL（μmol/L）	444.56 ± 75.94	39.20 ± 5.94^*	16.80 ± 6.24^*
直接胆红素（μmol/L）	227.48 ± 59.67	23.12 ± 10.22^*	5.52 ± 11.05
间接胆红素（μmol/L）	170.12 ± 25.79	47.92 ± 15.91^*	24.60 ± 22.78^*
肌酐（μmol/L）	335.12 ± 98.48	10.84 ± 3.47	40.56 ± 9.17^*
尿素氮（mmol/L）	50.88 ± 10.21	4.44 ± 1.36	19.68 ± 8.08^*
MELD评分	25.44 ± 2.47	23.60 ± 3.74^*	12.80 ± 4.12^*

检验项目	人工肝治疗前	人工肝治疗2 h	人工肝治疗结束
Ca_-tot（mmol/L）	2.22 ± 0.12	2.23 ± 0.08	2.28 ± 0.14
Ca_-ion（mmol/L）	1.12 ± 0.09	1.05 ± 0.10	1.05 ± 0.09
Ca_-tot/Ca_-ion	2.05 ± 0.06	2.14 ± 0.20	2.21 ± 0.02

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Observation on the application effect of local citrate anticoagulation in CRRT tandem artificial liver treatment

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