Regional Citrate Anticoagulation versus No-Anticoagulation for Continuous Venovenous Hemofiltration in Acute Severe Hypernatremia Patients with Increased Bleeding Risk: A Retrospective Cohort Study
Regional Citrate Anticoagulation versus No-Anticoagulation for Continuous Venovenous Hemofiltration in Acute Severe Hypernatremia Patients with Increased Bleeding Risk: A Retrospective Cohort Study
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局部柠檬酸盐抗凝与不抗凝治疗出血风险增加的急性重度高钠血症患者的连续静脉静脉血液滤过：一项回顾性队列研究
DOI：
10.1159/000502937
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发表时间：
2019-09
影响因子：
3
通讯作者：
Sun Shiren
中科院分区：
文献类型：
--
作者：
Zhao Lijuan;Ma Feng;Yu Yan;Li Yangping;Wang Yan;He Lijie;Zhou Meilan;Tian Xiujuan;Jing Rui;Li Li;Li Lu;Huang Chen;Bai Ming;Sun Shiren
目的：本研究旨在评价局部柠檬酸盐抗凝（RCA）与无抗凝连续性静脉-静脉血液滤过（CVVH）在出血风险增加的急性重度高钠血症患者中的有效性和安全性。材料与方法：2011年1月至2017年10月期间在我中心接受CVVH的具有高出血风险的急性重度高钠血症患者被视为候选人。排除年龄<18岁、低血容量性高钠血症和全身抗凝治疗的患者。根据CVVH期间的抗凝策略，将入选患者分为RCA组和无抗凝组，并根据年龄、序贯器官衰竭评估评分和血管加压药依赖性进行匹配。结果：在纳入的64例患者中，分别有23例和41例患者采用无抗凝和RCA进行CVVH。无抗凝组和RCA组之间的血清钠降低率（RRSeNa）无显著差异（p = 0.729）。与无抗凝相比，RCA显著延长了回路存活时间（15 h [4.1-23.9] vs. 51 h [21.3-80.7]，p = 0.001）。无抗凝组和RCA组的滤器失效发生率分别为65.2%（15/23）和2.4%（1/41）（p < 0.001）。在匹配队列中，两组之间的RRSeNas无差异（p = 0.569），RCA组的滤器寿命也显著更长（p < 0.001）。结论：RCA对接受CVVH治疗的急性重度高钠血症患者安全有效。进一步的前瞻性、随机、对照试验是必要的，以获得可靠的证据。
Purpose: This study was aimed at evaluating the efficacy and safety of regional citrate anticoagulation (RCA) versus no-anticoagulation continuous venovenous hemofiltration (CVVH) in acute severe hypernatremia patients with increased bleeding risk. Materials and Methods: Acute severe hypernatremia patients with high bleeding risk who underwent CVVH in our center between January 2011 and October 2017 were considered as candidates. Patients who were <18 years old, with hypovolemic hypernatremia, and had systemic anticoagulation were excluded. The included patients were divided into RCA and no-anticoagulation groups according to their anticoagulation strategy during CVVH and matched by age, sequential organ failure assessment scores, and vasopressor dependency. Results: Of the 64 included patients, no-anticoagulation and RCA were employed for CVVH in 23 and 41 patients, respectively. The serum sodium reduction rate (RRSeNa) was not significantly different between the no-anticoagulation and RCA groups (p = 0.729). Compared to no-anticoagulation, RCA significantly prolonged the circuit survival time (15 h [4.1–23.9] vs. 51 h [21.3–80.7], p = 0.001). The incidence of filter failure was 65.2% (15/23) in the no-anticoagulation group and 2.4% (1/41) in the RCA group (p < 0.001), respectively. In the matched cohort, the RRSeNas were not different between the 2 groups (p = 0.569), and the filter lifespan was significantly longer in the RCA group as well (p < 0.001). Conclusion: RCA might be safe and effective for acute severe hypernatremia patients who underwent CVVH treatment. Further prospective, randomized, control trials are warranted to obtain robust evidences.
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影响因子：
38.9
作者：
Funk, Georg-Christian;Lindner, Gregor;Metnitz, Philipp G. H.
通讯作者：
Metnitz, Philipp G. H.
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
高钠血症的不足是频繁的，并且与死亡率有关。
影响因子：
2.3
作者：
Bataille S;Baralla C;Torro D;Buffat C;Berland Y;Alazia M;Loundou A;Michelet P;Vacher-Coponat H
通讯作者：
Vacher-Coponat H
DOI：
10.1186/cc7162
发表时间：
2008
期刊：
Critical care (London, England)
影响因子：
--
作者：
Stelfox HT;Ahmed SB;Khandwala F;Zygun D;Shahpori R;Laupland K
通讯作者：
Laupland K
影响因子：
13.2
作者：
Wu, Mei-Yi;Hsu, Yung-Ho;Tam, Ka-Wai
通讯作者：
Tam, Ka-Wai