Study On The Effects Of Different Anticoagulants In Critically Ill Patients With CRRT

Objective:Continuous Renal Replacement Therapy plays an inreplaceable role in the treatment of critically ill patients,and the choice of anticoagulation is the key to ensure the smooth progress of CRRT.What kind of anticoagulation method can maximize the efficiency of the filter,there are different opinions in the research reports at home and abroad.This study was a retrospective study.Regional citrate anticoagulation and regional heparin anticoagulation were selected to compare the advantages and disadvantages of the two regional anticoagulation methods in critically ill patients from the aspects of filter life,prognosis and related costs,so as to provide a credible basis for which anticoagulation methods should be adopted.Methods:The critically ill patients who accepted CRRT in the affiliated Hospital of Chengde Medical College from 2014 to 2017 were retrospectively analyzed.They were divided into two groups: regional citrate anticoagulation group and regional heparin anticoagulation group according to different anticoagulation regimens.1.Count the filter life of the two groups;2.At the same time,the coagulation function,PH,liver function,renal function and electrolytes before and after CRRT(12h,24 h,48h,72h)in both groups;3.Statistics of the two groups of patients with new blood events,hypocalcemia,metabolic alkalosis,28-day mortality;4.Statistics of the two groups of patients due to the need to replace the filter related costs;5.Statistical analysis: spss19.0 software was used for analysis.The measurement data were expressed by mean ±standard deviation(variance x ±s)and median ±quartile spacing.T-test was used for comparison between the two groups,and two-factor repeated measurement analysis of variance was used for intra-group and inter-group comparison.The counting data were analyzed by χ 2 test and Fisher exact probability method.Filter life and 28-day mortality were compared by Kaplan-Meier survival curve analysis and Log-rank test.The difference was statistically significant(P< 0.05).Results:A total of 102 eligible patients were included in this study,including 43 patients who died of family abandonment,CRRT less than 72 hours and complete case data.There were 31 patients in RCA group and 28 patients in heparin group.The results of the two groups are as follows:1.Compare in age,sex ratio,diagnosis of primary disease and APACHE Ⅱ score between the two groups(22.19 ±5.24)vs(24.75 ±5.39).There was no significant difference(P>0.05).2.The filter life of the two groups was(47.28 ±20.43)h and(22.97 ±10.03)h,respectively.The use time of the filter in the RCA group was significantly longer than that in the heparin group.The times of completing the whole set(the use time of the filter and the pipe reached 72 h)in the two groups were 7 and 0 times,respectively.The unplanned times of the two groups were 12 and 94 times,respectively.There was significant difference between the two groups(P<0.05).3.The blood coagulation function of the two groups was monitored before CRRT,including prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT).The PT of the two groups were compared before and after CRRT,and the APTT and TT of the RCA group were compared before and after CRRT.There was no significant difference between the two groups(P>0.05).In heparin group,APTT and TT at each time point after CRRT were significantly longer than those before CRRT,and the difference was statistically significant(P<0.05).4.The levels of serum creatinine(SCr)in the two groups after CRRT treatment were significantly lower than those before treatment,and there was no significant difference between the two groups in terms of SCr level at each time point after treatment(P>0.05).There was no significant difference in Na+、 K+ and Ca2+ before CRRT between the two groups,but there was no significant difference in Na+、 K+ and Ca2+ between the two groups after treatment and at each time point(P>0.05).The changes of K+ and Ca2+ in the two groups after treatment were significantly different from those before treatment(P<0.05).5.There was no significant difference in newly emerging blood events,hypocalcemia and metabolic complications between the two anticoagulation methods(P>0.05).6.The number of deaths within 28 days between the two groups was 6 and 10 respectively,and there was no significant difference between the two groups(P>0.05).There was a significant difference in the cost of replacing the filter between the two groups [(3906 ±3906)vs(11718 ±7812)](P<0.05).Conclusion:1.The two regional anticoagulant methods can effectively remove metabolic waste and correct electrolyte disturbance in the process of CRRT.2.Regional citrate anticoagulation is superior to regional heparin anticoagulation regimen in prolonging filter life and reducing per capita cost of filter replacement in critically ill patients with CRRT.3.Regional citrate anticoagulation is similar to regional heparin anticoagulation in prognosis,new bleeding events,hypocalcemia and metabolism in critically ill patients.