Regional citrate anticoagulation versus low molecular weight heparin anticoagulation for continuous venovenous hemofiltration in patients with severe hypercalcemia: a retrospective cohort study
Regional citrate anticoagulation versus low molecular weight heparin anticoagulation for continuous venovenous hemofiltration in patients with severe hypercalcemia: a retrospective cohort study
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区域柠檬酸盐抗凝与低分子肝素抗凝治疗严重高钙血症患者连续静脉-静脉血液滤过：一项回顾性队列研究
DOI：
10.1080/0886022x.2020.1795879
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发表时间：
2020-01
期刊：
影响因子：
3
通讯作者：
Sun Shiren
中科院分区：
文献类型：
--
作者：
Yu Yan;Bai Ming;Wei Zhang;Zhao Lijuan;Li Yangping;Ma Feng;Sun Shiren
摘要目的比较局部柠檬酸抗凝(RCA)与低分子肝素(LMWH)抗凝治疗重度高血钙患者CVVH的疗效和安全性。方法2014年1月至2019年5月，33例重度高血钙症患者接受CVVH治疗。将患者分为RCA组和LMWH组。使用无钙替代液。以血清总钙减少率(RRSeCa)、滤器寿命、出血、总钙/离子钙比值、柠檬酸蓄积和导管堵塞为评价指标。结果14个滤器采用RCA，43个滤器采用低分子肝素治疗CVVH。低分子肝素组和右室静脉组之间RRSeCa无显著差异(p = .320)，但右室静脉组在半数时间点降低钙离子的效果更好(p <； .05)。RCA显著延长了过滤器的中位寿命(>；72 h vs.24.0 h[IQR15.0-26.0]，p = .012)。低分子肝素组滤过失败率为55.8%(24/43)，右冠状动脉组为21.4%(3/14)(p = .033)。调整后的结果显示，RCA可显著降低滤过失败的风险(p = .043，95%CI 0.059-0.957，HR=0.238)。RCA-CVVH组未见柠檬酸蓄积或出血。LMWH-CVVH组出血7例(16.3%)。结论在接受CVVH治疗的重度高钙血症患者中，RCA较LMWH更有效地降低血钙水平，具有更好的滤器寿命，且无明显不良反应。进一步的前瞻性、随机性、对照研究是必要的，以获得可靠的证据。
Abstract Purpose We conducted a retrospective study to evaluate the efficacy and safety of regional citrate anticoagulation (RCA) versus those of low molecular weight heparin (LMWH) anticoagulation for CVVH in severe hypercalcemia patients. Methods Between January 2014 and May 2019, 33 severe hypercalcemia patients underwent CVVH. Patients were divided into the RCA and LMWH groups. Calcium-free replacement solution was used. Serum total calcium reduction rate (RRSeCa), filter lifespan, bleeding, totCa/ionCa ratio, citrate accumulation, and catheter occlusion were evaluated as outcomes. Results RCA and LMWH were employed for CVVH in 14 and 43 filters, respectively. RRSeCa was not significantly different between the LMWH and RCA groups (p = .320), but RCA-CVVH was more effective in reducing ionized calcium at half of the time points (p < .05). RCA significantly prolonged the median filter lifespan (>72 h vs. 24.0 h [IQR, 15.0–26.0], p = .012). The incidence of filter failure was 55.8% (24/43) in the LMWH group and 21.4% (3/14) in the RCA group (p = .033). The adjusted results demonstrated that RCA could significantly reduce the risk of filter failure (p = .043, 95% CI 0.059–0.957, HR = 0.238). No citrate accumulation or bleeding episodes were observed in the RCA-CVVH group. Seven bleeding episodes (7/43, 16.3%) occurred in the LMWH-CVVH group. Conclusions In patients with severe hypercalcemia who underwent CVVH, RCA more effectively decreased calcium levels and had a superior filter lifespan and no obvious adverse events compared with LMWH. Further prospective, randomized, controlled studies are warranted to obtain robust evidence.
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影响因子：
5.5
作者：
通讯作者：
--
DOI：
10.1186/cc9358
发表时间：
2011-01-24
期刊：
Critical care (London, England)
影响因子：
--
作者：
Oudemans-van Straaten HM;Kellum JA;Bellomo R
通讯作者：
Bellomo R
影响因子：
13.2
作者：
Wu, Mei-Yi;Hsu, Yung-Ho;Tam, Ka-Wai
通讯作者：
Tam, Ka-Wai
影响因子：
9
作者：
C. Wang;S. Guyton
通讯作者：
C. Wang;S. Guyton
影响因子：
38.9
作者：
Uchino, S;Fealy, N;Bellomo, R
通讯作者：
Bellomo, R