The Application Of Regional Citrate Anticoagulation In Continuous Blood Purification

Background: Continuous blood purification (CBP) is one of the important progress in the treatment of severe acute renal failure and multiple organ dysfunction syndrome (MODS) in critical illness in recent years. Patients with critical illness is often accompanied with various degrees of bleeding tendency, but the role of heparin anticoagulation is one of the most important reasons caused systemic bleeding complications. CBP anticoagulation has become the bottleneck of CBP technology in clinical application. Therefore, scholars have been so unremitting efforts, such as the use of low molecular weight heparin, prostaglandin and other new types of anticoagulants, non-heparin anticoagulation methods. However, these all can not fundamentally solve the problem of bleeding in patients with high risk of anticoagulant CBP issues. In this study, drawing on the method of blood preservation of anticoagulation- citrateanticoagulation , used in its attempt to CBP anticoagulant. To explore its efficacy and safety, at the same time to explore a set quantitative, simple, practical program of citrate anticoagulation.Objective: We apply the sodium citrate solution (blood preservation solution I) as an anticoagulant in continuous blood purification(CBP),observe the treatment of anticoagulant effects and the efficiency in continuous venovenous hemofiltration (CVVH) and opportunely simplify anticoagulation monitoring indicators, with a view to be more simple and effective Regional Citrate Anticoagulation (RCA) program.Methods: 25 patients CBP treatment were divided into two groups: group of local citrate anticoagulation (RCA) and low-dose heparin group. 12 patients in RCA group, applied CVVH 30 cases. Patients in low-dose heparin group 13 cases, applied CVVH 30 cases. Monitoring the pre-filter and post-filter activated whole blood clotting time (ACT) and serum ionized calcium (iCa) in pre-treatment, treatment2h, 4h, 8h and 30min after treatment. We observe the coagulation during cardiopulmonary bypass and the clinical bleeding events; monitor the before treatment and 30min after treatment of blood pH and iCa, sodium (Na +), blood bicarbonate (HCO3-), blood urea (Urea), serum creatinine (SCr) concentration, decline in the calculation of urea (URR).Results: In RCAgroup,the ACT and iCa of pre-filter altered little during the treatment,but the ACT and iCa of post-filter showed obvious prolongation as compared with pre-filter(P<0.01) during2,4,8hours.The filter clotting is less than low-dose heparin group (P<0.05 ) .The blood pH, Na +, iCa, HCO3- after treatment with no increased significantly compared with the pre-treatment (P>0.05).The blood Urea, SCr after treatment decreased significantly than pre-treatment in both groups. The URR of RCA Group compare with low-dose heparin group were significantly different (P <0.05)Conclusion: 1.Sodium citrate anticoagulation during cardiopulmonary bypass can maintain a long time and the treatment efficiency is not affected. 2.The blood electrolyte,pH in patients after treatment can be maintained at normal range, there was no hypernatremia and complications such as metabolic alkalosis. 3.There was a good negative correlation between post-filter ACT and iCa. We can test iCa instead of ACT to simplify anticoagulation monitoring indicators and strengthen the safety.