目的 了解重症监护病房（ICU）局部枸橼酸抗凝（RCA）在肾脏替代治疗中的开展现状及ICU医师对RCA的认知情况。 方法 本研究设计为现况调查。研究者自行设计问卷（包括3个部分，共20个问题），主要了解接受调查者一般信息，对RCA的认知情况和所在ICU目前RCA实施的具体流程。问卷通过线上平台发放及回收，国内ICU临床医师自愿参与。调查时间为2022年4月15日至2022年4月30日。对获得的数据进行描述性统计分析。 结果 共回收630份电子问卷，确认有效的为616份（问卷有效率为97。8%）。616位医师来自全国21个省、4个直辖市、4个自治区和1个特别行政区的587个ICU，其中来自三级医院者530位，具有高级职称者302位。488个（83。1%，488/587）ICU开展了RCA（503位医师），ICU性质（综合、内科、外科、专科ICU）与是否开展RCA无明显相关性。ICU开展RCA的主要原因为出血风险小（96。4%，485/503），监测方便（62。2%，313/503）和指南推荐（62。0%，312/503）。99个（16。9%，99/587）ICU未开展RCA（113位医师），不开展的原因主要为医院无枸橼酸钠抗凝剂（58。4%，66/113），其次为无使用经验或方案、价格贵（各14。2%，16/113）等。所在ICU开展RCA的503位医师中，443位（88。1%）医师认为严重肝功能不全（Child分级B以上）是RCA禁忌证；分别有388位（77。1%）和377位（75。0%）医师认为代谢性碱中毒和低钙血症是RCA并发症；273位医师执行每日规律监测总钙/离子钙比值；分别有276位（54。9%）和181位（36。1%）医师将血流速度设置在120~150 ml/min和151~180 ml/min；377位（74。9%）医师选择成品血液滤过基础液，252位（50。1%）医师稀释方式选择前稀释+后稀释；239位（47。6%）医师通过单独静脉通路补充碳酸氢钠注射液；400位（79。5%）医师选择枸橼酸钠剂量方案为每小时输注速度是每分钟血流速度的1。2~1。5倍。 结论 目前国内综合性ICU在肾脏替代治疗中普遍开展RCA，且相关临床医师对RCA的禁忌证和潜在并发症等已有一定的认识，但不同医院在实施RCA时所采用的方案各异，监测手段也尚未形成统一标准。 Objective To understand the current status of regional citrate anticoagulation (RCA) application in patients of Intensive Care Units (ICUs) and physicians′ thoughts on RCA。 Methods This study was designed as a status quo survey。 Researchers independently designed a questionnaire (3 parts， 20 questions in total) and gathered data from 3 aspects， including general information of respondents， their thoughts of RCA， and the specific processes of RCA implementation in their ICUs。 The survey was conducted online， and clinicians in ICUs across the country voluntarily participated from April 15 to April 30， 2022。 Descriptive statistical analysis was performed to analyze the collected data。 Results A total of 630 electronic questionnaires were collected， of which 616 were confirmed as valid (an effective rate of 97。8%)。 These 616 physicians came from 587 ICUs in 21 provinces， 4 municipalities， 4 autonomous regions， and 1 special administrative region across the country。 Among them， 530 were from hospitals of 3A-level， and 302 held senior professional titles。 RCA was implemented in 488 (83。1%， 488/587) ICUs (involving 503 physicians)， and no significant correlation was found between the type of ICU (general， internal medicine， surgical， or specialized) and whether RCA was conducted or not。 The main reasons for RCA implementation in ICUs included having lower risk of bleeding (96。4%， 485/503)， convenient monitoring (62。2%， 313/503)， and guideline recommendations (62。0%， 312/503)。 RCA was not implemented in 99 (16。9%， 99/587) ICUs (involving 113 physicians)， and the main reasons for not carrying out RCA were the absence of citrate sodium in hospitals (58。4%， 66/113)， followed by lack of experience or protocols and higher cost (each 14。2%， 16/113)。 Among the 503 physicians in ICUs implementing RCA， 443 physicians (88。1%) believed that severe liver dysfunction (Child grade B and above) was a contraindication for RCA 388 physicians (77。1%) and 377 physicians (75。0%) recognized metabolic alkalosis and hypocalcemia as complications of RCA， respectively 273 physicians regularly monitored the total calcium/ionized calcium ratio daily 276 physicians (54。9%) and 181 physicians (36。1%) set the blood flow rate at 120-150 ml per minute and 151-180 ml per minute， respectively 377 physicians (74。9%) chose prepackaged replacement fluids， with pre-dilution+post-dilution as the dilution method (252 physicians， 50。1%) 239 physicians (47。6%) added sodium bicarbonate injection via a separate intravenous route 400 physicians (79。5%) used a citrate sodium dosage plan of 1。2-1。5 times the blood flow rate per minute per hour。 Conclusions Currently， RCA is widely implemented in comprehensive ICUs in China， and relevant clinical physicians have certain knowledge of its contraindications and potential complications。 However， different hospitals use varied protocols in implementing RCA， and a unified standard of monitoring method have not yet formed。
Current status of regional citrate anticoagulation application in renal replacement therapy for critically ill patients
Objective To understand the current status of regional citrate anticoagulation (RCA) application in patients of Intensive Care Units (ICUs) and physicians′ thoughts on RCA. Methods This study was designed as a status quo survey. Researchers independently designed a questionnaire (3 parts, 20 questions in total) and gathered data from 3 aspects, including general information of respondents, their thoughts of RCA, and the specific processes of RCA implementation in their ICUs. The survey was conducted online, and clinicians in ICUs across the country voluntarily participated from April 15 to April 30, 2022. Descriptive statistical analysis was performed to analyze the collected data. Results A total of 630 electronic questionnaires were collected, of which 616 were confirmed as valid (an effective rate of 97.8%). These 616 physicians came from 587 ICUs in 21 provinces, 4 municipalities, 4 autonomous regions, and 1 special administrative region across the country. Among them, 530 were from hospitals of 3A-level, and 302 held senior professional titles. RCA was implemented in 488 (83.1%, 488/587) ICUs (involving 503 physicians), and no significant correlation was found between the type of ICU (general, internal medicine, surgical, or specialized) and whether RCA was conducted or not. The main reasons for RCA implementation in ICUs included having lower risk of bleeding (96.4%, 485/503), convenient monitoring (62.2%, 313/503), and guideline recommendations (62.0%, 312/503). RCA was not implemented in 99 (16.9%, 99/587) ICUs (involving 113 physicians), and the main reasons for not carrying out RCA were the absence of citrate sodium in hospitals (58.4%, 66/113), followed by lack of experience or protocols and higher cost (each 14.2%, 16/113). Among the 503 physicians in ICUs implementing RCA, 443 physicians (88.1%) believed that severe liver dysfunction (Child grade B and above) was a contraindication for RCA 388 physicians (77.1%) and 377 physicians (75.0%) recognized metabolic alkalosis and hypocalcemia as complications of RCA, respectively 273 physicians regularly monitored the total calcium/ionized calcium ratio daily 276 physicians (54.9%) and 181 physicians (36.1%) set the blood flow rate at 120-150 ml per minute and 151-180 ml per minute, respectively 377 physicians (74.9%) chose prepackaged replacement fluids, with pre-dilution+post-dilution as the dilution method (252 physicians, 50.1%) 239 physicians (47.6%) added sodium bicarbonate injection via a separate intravenous route 400 physicians (79.5%) used a citrate sodium dosage plan of 1.2-1.5 times the blood flow rate per minute per hour. Conclusions Currently, RCA is widely implemented in comprehensive ICUs in China, and relevant clinical physicians have certain knowledge of its contraindications and potential complications. However, different hospitals use varied protocols in implementing RCA, and a unified standard of monitoring method have not yet formed.
Intensive care unitsAnticoagulantsRenal replacement therapyRegional citrate anticoagulation
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