Study on efficacy and safety of local citric acid anticoagulation and continuous renal replacement therapy(CRA-CRRT)therapy in severe patients with hyperlactatemia
Objective To investigate the efficacy and safety of local citric acid anticoagulation(CRA)and continuous renal replacement therapy(CRRT)in severe patients with hyperlactacemia.Methods The clinical data of 67 severe patients with hyperlactacemia(2 mmol/L＜lactic acid value＜10 mmol/L)who were treated with RCA-CRRT in the Respiratory intensive Care Unit of the hospital from October 2021 to March 2023 were collected.The patients were divided into control group(low molecular weight heparin anticoagulation)20 cases and CRA group(citric acid anticoagulation)47 cases.General data and lactic acid value,pH value,bicarbonate ion(HCO3),post-filter serum calcium(iCa2+),in vivo iCa2+,serum total calcium,serum sodium(Na+),magnesium(Mg2+)were collected before and 24 h after CRRT treatment.Filter outcomes,blood product transfusions,bleeding event rates and mortality were counted and CRA-re-lated complications were recorded.Results There was no significant difference in general data between the 2 groups(P＞0.05).Compared with this group before the treatment,lactic acid levels were decreased and iCa2+,pH and HCO3 levels were increased in both groups after 24 hours of CRRT treatment(P＜0.05).After 24 hours of CRRT treatment,there were no significant differences in total calcium,total cal-cium/iCa2+ratio,Na+and Mg2+levels between the 2 groups(P＞0.05).Compared with the control group,the average service life of the filter in the CRA group was extended(P＜0.05),and there were no significant differences in the incidence of bleeding events,blood product infusion and mortality between the 2 groups during treatment(P＞0.05).There was statistical significance in the grade distribution of colter or tube clotting incidence between the 2 groups after 24 hours treatment(P＜0.05),and the grade Ⅱ/Ⅲ clotting incidence in the CRA group was lower than that in the control group(P＜0.05).There was no significant difference in the incidence of citric acid accumulation,metabolic acidosis,metabolic alkalosis and total complications between the 2 groups(P＞0.05).Conclusion In severe patients with hyperlacta-cemia,CRA-CRRT treatment is helpful to reduce blood lactic acid level,correct acidosis,reduce the risk of coagulation,extend the filter life,do not increase the risk of bleeding and bleeding,prolong filter life and lower the risk of citric acid accumulation.
万方数据
维普
