A comparison of two citrate anticoagulation regimens for continuous veno-venous hemofiltration
A comparison of two citrate anticoagulation regimens for continuous veno-venous hemofiltration
复制标题
DOI：
10.1177/039139880502801203
复制
发表时间：
2005-12-01
影响因子：
1.7
通讯作者：
Baldwin, I
中科院分区：
文献类型：
--
作者：
Egi, M;Naka, T;Baldwin, I
目的：评价两种不同的含柠檬酸盐预滤液在连续性静脉-静脉血液滤过(CVVH)治疗滤器频繁凝血患者中的安全性和有效性。环境：四个重症监护室。患者：63例急性肾功能衰竭(ARF)危重患者。设计：前瞻性观察研究。方法：我们用市售柠檬酸盐液(柠檬酸：11 mmo1/L-A液)作为CVVH的预稀释替代品。然后我们改用一种新的商品柠檬酸盐液(柠檬酸盐：14 mmol/L-B液)作为替换液，并进行统计学比较。结果：A液滤器寿命为12.2h，B液滤器平均寿命为17.1h(p=0.0001)。A液滤后平均钙离子浓度为0.52mmoL/L，B液为0.40mmoL/L(p<；0.0001)。1例A液和1例B液患者因柠檬酸不耐受而停止治疗。在A液治疗期间，总的离子钙水平较高(A：1.18vs B：1.13mmoL/L；p<；0.0001)，而碳酸氢盐水平较低(A：22.4vs B：24.5mmoL/L；p<；0.0001)。将柠檬酸浓度从11 mmo1/L增加到14 mmo1/mmo1，在保持相对安全和简单的同时，延长了过滤器的使用寿命。
Aims: To assess the safety and efficacy of two different commercial citrate containing pre-filter replacement fluids during continuous veno-venous hemofiltration (CVVH) in patients with frequent filter clotting. Setting: Four intensive care units. Patients: Sixty-three critically ill patients with acute renal failure (ARF). Design: Prospective observational study.Methods: We used a commercial citrate fluid (citrate: 11 mmol/L -fluid A) as predilution replacement for CVVH. We then changed to a new commercial citrate fluid (citrate: 14 mmol/L-fluid B) as replacement fluid and performed statistical comparisons. Replacement fluid rate was fixed at 2,000 ml/hour.Results: Filter life was 12.2 hour with fluid A compared with 17.1 hour with fluid B on average (p = 0.0001). Mean post filter ionized calcium concentration was 0.52 mmol/L with fluid A compared with 0.40 mmol/L with fluid B (p < 0.0001). Citrate intolerance led to cessation of treatment in one patient with fluid A and one patient with fluid B. Overall ionized calcium levels were higher (A: 1.18 vs B: 1.13 mmol/L; p < 0.0001) and bicarbonate was lower (A: 22.4 vs B: 24.5 mmol/L; p < 0.0001) during treatment with fluid A. Alkalemia was seen in 10 patients treated with fluid A and 16 patients treated with fluid B (NS).Conclusions: We have developed a simple approach to regional citrate anticoagulation for CVVH using a commercial citrate-containing fluid as replacement fluid. Increasing citrate concentration from 11 to 14 mmol/L increased filter life while maintaining relative safety and simplicity.