2022 年第 4 期 第 17 卷

枸橼酸局部抗凝对连续性肾脏替代治疗连接体外膜氧合时滤器的影响

Effect of local anticoagulation of citrate on filters in patients with continuous renal replacement therapy and extracorporeal membrane oxygenation

作者：辛萌王红王坚刚贾明侯晓彤

英文作者：Xin Meng Wang Hong Wang Jiangang Jia Ming Hou Xiaotong

单位：首都医科大学附属北京安贞医院心脏外科危重症中心，北京100029

英文单位：Cardiac Surgery Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：体外膜氧合；连续性肾脏替代治疗；滤器；枸橼酸抗凝 

英文关键词：Extracorporealmembraneoxygenation;Continuousrenalreplacementtherapy;Filters;Anticoagulationofcitrate

• 摘要：

• 目的 探讨枸橼酸局部抗凝对连续性肾脏替代治疗（CRRT）连接体外膜氧合（ECMO）时CRRT滤器的影响。方法 回顾性分析2015年6月至2018年3月于首都医科大学附属北京安贞医院行CRRT+ECMO治疗的患者108例的临床资料。共用滤器319例次，排除因撤除ECMO而被迫停用的滤器5例次、CRRT单独置管的滤器8例次以及数据不全的滤器4例次，最终纳入98例患者、使用滤器302例次。根据枸橼酸使用情况分为枸橼酸组（48例患者，使用滤器159例次）和非枸橼酸组（50例患者，使用滤器143例次）。所有患者CRRT管路直接连接于ECMO环路，非枸橼酸组接受ECMO常规抗凝，枸橼酸组在ECMO常规抗凝基础上予CRRT局部应用枸橼酸钠抗凝。记录患者基线资料,比较2组滤器使用情况、单个滤器使用时间及患者输血量。采用Kaplan-Meier生存曲线分析2组患者的滤器使用效率。结果 2组年龄、性别、高血压病、脑血管病史、糖尿病、吸烟史比例比较差异均无统计学意义（均P＞0.05）。枸橼酸组因心源性休克使用的滤器明显多于非枸橼酸组，因心脏骤停使用的滤器明显少于非枸橼酸组，单个滤器使用时间长于非枸橼酸组［46（36，61）h比42（31，56）h］，差异均有统计学意义（均P＜0.05）。Kaplan-Meier生存曲线分析结果显示，枸橼酸组滤器使用效率明显高于非枸橼酸组（P＜0.001）。在行CRRT+ECMO治疗期间，2组总输血量比较差异无统计学意义［200（200,300）ml比200（100,300）ml］（P=0.953），但枸橼酸组单位时间输血量明显少于非枸橼酸组［4.5（2.8,6.9）ml/h比5.6（2.8,8.9）ml/h］（P=0.041）。结论 枸橼酸局部抗凝可以延长行CRRT+ECMO患者的单个滤器使用时间，增加滤器使用效率，减少单位时间输血量。

• Objective To explore the effect of local anticoagulation of citrate on filters in patients with continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO). Methods From June 2015 to March 2018, clinical data of 108 patients with CRRT+ECMO in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. Totally 319 times of filters were used. Five times of filters that were forced to stop due to withdrawal of ECMO, 8 times of filters indicidually in CRRT and 4 times of filters with incomplete data were excluded, and there were 98 patients with 302 times of filters finally. According to the use of citrate, they were divided into citrate group (48 patients with 159 times of filters) and non citrate group (50 patiens with 143 times of filters). The CRRT line for all patients was connected directly to the ECMO loop. The non citrate group was treated with routine anticoagulation of ECMO and the citrate group was treated with local anticoagulation of citrate of sodium citrate in CRRT based on routine anticoagulation of ECMO. The baseline data of patients were recorded. The use of filters, service time of single filter and patients′ blood transfusion volume were compared between the two groups. Kaplan-Meier survival curve analysis was used to anlyze the service efficiency of filters between the two groups. Results There were no significant differences in age, proportions of gender, hypertension, cerebrovascular history, diabetes mellitus and smoking history (all P>0.05). The number of filters for cardiogenic shock in the citrate group was more than that in the non citrate group, the number of filters for cardiac arrest in the citrate group was less than that in the non citrate group, and service time of single filter in the citrate group was longer than that in the non citrate group ［46（36，61）h vs 42（31，56）h］(all P<0.05). Kaplan-Meier survival curve analysis showed that the service efficiency of filter in the citrate group was significantly higher than that in the non citrate group (P<0.001). During CRRT+ECMO, there was no significant difference in total blood transfusion volume between the two groups ［200（200,300）ml vs 200（100,300）ml］（P=0.953）, while the blood transfusion volume per unit time in the citrate group was less than that in the non citrate group［4.5（2.8,6.9）ml/h vs 5.6（2.8,8.9）ml/h］ （P=0.041）. Conclusion Local anticoagulation of citrate can expand the service time of single filter in patients with CRRT+ECMO, increase filters efficiency, and reduce the blood transfusion volume per unit time.