Impact of Transfused Citrate on Pathophysiology in Massive Transfusion.
Impact of Transfused Citrate on Pathophysiology in Massive Transfusion.
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DOI：
10.1097/cce.0000000000000925
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发表时间：
2023-06
影响因子：
--
通讯作者：
中科院分区：
文献类型：
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作者：
这篇叙述性综述文章试图突出柠檬酸盐在出血患者大量输血过程中对生理的影响。检索关键词包括“柠檬酸盐中毒”、“柠檬酸盐大量输注”、“柠檬酸盐药代动力学”、“创伤低钙血症”、“柠檬酸盐磷酸葡萄糖”和“大量输血中的低钙血症”，建立有限的文献资料库。综述文章以及前瞻性和回溯性研究是根据它们与纳入本综述的相关性而选择的。鉴于相关研究的数量有限，对以英语编写的研究进行了审查，并将其包括在内。这既不是系统回顾，也不是荟萃分析。由于这不是荟萃分析，因此没有进行新的统计分析。正文部分对相关数据进行了总结。与低血钙症无关的柠檬酸盐的生理作用还知之甚少。虽然健康的人可以快速清除单位血液中的柠檬酸盐(通过柠檬酸循环或直接从尿液中排泄)，但失血性休克的生理学可能会导致柠檬酸盐清除减少和循环时间延长。出血的所谓“死亡之钻”--凝血障碍、酸血症、体温过低和低钙血症--与柠檬酸盐有动态的相互作用，可能导致死亡螺旋。体温过低和酸血症都会降低柠檬酸盐的清除量，而循环中的柠檬酸盐则会降低凝血酶的生成和血小板功能，导致电离性低钙血症、凝血障碍和需要进一步输血，从而产生新的柠檬酸盐负荷。与单独使用成分疗法相比，全血输血通常需要更少的输血产品，从而产生更低的柠檬酸盐负担。应努力限制失血性休克患者输注柠檬酸的量，同时解决诱发的低钙血症。
This narrative review article seeks to highlight the effects of citrate on physiology during massive transfusion of the bleeding patient. A limited library of curated articles was created using search terms including “citrate intoxication,” “citrate massive transfusion,” “citrate pharmacokinetics,” “hypocalcemia of trauma,” “citrate phosphate dextrose,” and “hypocalcemia in massive transfusion.” Review articles, as well as prospective and retrospective studies were selected based on their relevance for inclusion in this review. Given the limited number of relevant studies, studies were reviewed and included if they were written in English. This is not a systematic review nor a meta-analysis. As this is not a meta-analysis, new statistical analyses were not performed. Relevant data were summarized in the body of the text. The physiologic effects of citrate independent of hypocalcemia are poorly understood. While a healthy individual can rapidly clear the citrate in a unit of blood (either through the citric acid cycle or direct excretion in urine), the physiology of hemorrhagic shock can lead to decreased clearance and prolonged circulation of citrate. The so-called “Diamond of Death” of bleeding—coagulopathy, acidemia, hypothermia, and hypocalcemia—has a dynamic interaction with citrate that can lead to a death spiral. Hypothermia and acidemia both decrease citrate clearance while circulating citrate decreases thrombin generation and platelet function, leading to ionized hypocalcemia, coagulopathy, and need for further transfusion resulting in a new citrate load. Whole blood transfusion typically requires lower volumes of transfused product than component therapy alone, resulting in a lower citrate burden. Efforts should be made to limit the amount of citrate infused into a patient in hemorrhagic shock while simultaneously addressing the induced hypocalcemia.
DOI：
10.25100/cm.v51i4.4511
发表时间：
2020-12-30
期刊：
Colombia medica (Cali, Colombia)
影响因子：
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作者：
Salamea-Molina JC;Himmler AN;Valencia-Angel LI;Ordoñez CA;Parra MW;Caicedo Y;Guzmán-Rodríguez M;Orlas C;Granados M;Macia C;García A;Serna JJ;Badiel M;Puyana JC
通讯作者：
Puyana JC