Abstract:

Objective To investigate the efficacy and safety of continuous veno⁃venous hemofiltration dialysis（CVVHDF）with regional citrate anticoagulation （RCA）in critical patients with elevated lactic acid. Methods A retrospective analysis was conducted. A total of 235 patients with complete data of regional citrate anticoagulation continuous renal replacement therapy（CRRT）admitted to intensive care unit of our hospital from January 2019 to December 2020 were enrolled and divided into normal lactate group（Lac < 2 mmol/L，group A， n = 125）and elevated lactate group（Lac 2 ~ 10 mmol/L，group B，n = 110）. The basic information of patients in the two groups were compared，including lactic acid value，blood gas analysis（PH，bicarbonate），iCa2+，total serum calcium，total calcium/iCa2 + and Na + before and 24 h of CRRT treatment，and the occurrence of complica⁃ tions and the use of filters were recorded. Results There were no statistically significant differences in lactic acid value，PH and HCO3- before and after treatment in group A（P > 0.05），while lactic acid value decreased and PH and HCO3- increased after 24 h of CRRT treatment in group B（P < 0.05）. Before CRRT treatment，lactic acid in group B was higher than that of group A，while PH and HCO3- were lower than that of group A，with statistically significant differences（P < 0.05）. There were no significant differences in lactic acid，PH and HCO3- between two groups（P > 0.05）24 h after CRRT treatment. Six patients were diagnosed with citric acid accumulation（2.55%）， and all died with poor prognosis. There was no significant difference in the incidence of CRRT complications between group A and B（P > 0.05）. Conclusion Regional citrate anticoagulation was safe and effective for critical patients with elevated lactic acid during CVVHDF，but patients' blood gas，electrolytes and other indicators need to be closely monitored. The incidence of citric acid accumulation was low ，which only occurs in patients with severe lactic acidosis caused by multiple organ failure，and once occurred，it also indicated poor prognosis.

Key words:

continuous renal replacement therapy , regional citrate anticoagulation , lactic acid increased