Objective To investigate the clinical application of sodium citrate anticoagulant regimen in single plasma exchange therapy,and to evaluate the safety of this regimen.Methods A retrospective study was conducted on 52 patients admitted to the Renal Department of Hangzhou Hospital of Traditional Chinese Medicine from January 2015 to June 2022 who received single double plasma exchange.The patients were divided into the citric acid group and the low molecular weight heparin group according to the anticoagulation method.A total of 144 times of plasma exchange were performed.Anticoagulant regimen of citric acid group:4%citric acid was transfused before membrane plasma separator,adjusted according to the composition of the replacement liquid,and the flow rate of sodium citrate during plasma replacement was 120 mL/h.The flow rate of citric acid was adjusted to 140 mL/h when the albumin diluent and Ringer injection were replaced.The peripheral intravenous infusion of 5%calcium gluconate was performed with a micro-pump at a constant rate throughout the whole process according to the total amount of infusion and plasma exchange time.Anticoagulation regimen of LMWH group:according to the patient's body weight,a one-time intravenous injection of 60 to 80IU/kg was given 20 to 30 minutes before the treatment,and no additional injection was made during the treatment.The anticoagulation effect and the occurrence of adverse reactions were observed in the two groups.Results The citric acid group underwent plasma exchange 44 times without anticoagulation failure.In the low molecular weight heparin group,a total of 100 times of plasma exchange occurred,5 times of anticoagulation failure occurred,and no significant bleeding,hypocalcemia,muscle spasm and other complications occurred in the two groups.The proportion of filter grade 2 to 3,arterial and venous kettle clots in citric acid group were lower than those in low molecular weight heparin group(P<0.05).The changes of ionic calcium before and after citric acid anticoagulation were statistically significant(P=0.002),but all were within the normal range.The accumulation of sodium ions,PH,actual residual base,actual bicarbonate and citric acid was not significantly abnormal before and after the comparison.Conclusion Compared with traditional low molecular weight heparin,the anticoagulant effect of sodium citrate is more ideal,the application range is wider,and the single plasma exchange can be safely and effectively carried out.
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