Clinical Application Of Local Citrate Anticoagulation In Continuous Blood Purification In Children

Background:Continuous Blood Purification(CBP)is a long-term extracorporeal blood purification technique that lasts for 24 hours or more.It can play a role of kidney replacement,so it is also called continuous renal replacement therapy(CRRT).With the introduction of new equipment and the expansion of indications,its application opportunities in the field of pediatric critical care are gradually increasing,and it also has great space for development.Due to the small weight,low blood volume,and relatively slow blood flow during cardiopulmonary bypass.children’s complications such as blood coagulation and hemorrhage are more likely to occur during the treatment with the increase of treatment duration.Clinically,it has been searching for more effective and safe anticoagulants for children.In recent years,regional citrate anticoagulation has gradually been introduced into the clinic and has become a research hotspot.Objective:To understand the safety and efficacy of regional citrate anticoagulant in different treatment modes of continuous blood purification in children,and to provide a reference for the selection of clinical anticoagulation schemes of regional citratc anticoagulant in children with continuous blood purification.Methods:The clinical data of 92 children treated with CBP from July 2015 to July 2018 in the Department of Critical Care Medicine.Children’s Hospital Affiliated to Suzhou University were retrospectively analyzed.According to the treatment mode,they were divided into CVVH group and CVVHDF group.Each group was divided into regional citrate anticoagulation group(A group)and heparin anticoagulation group(B group)according to the anticoagulation method.The sex,age.weight.PICU stay time,total hospitalization time,CBP treatment time,each filter use time,pediatric critical illness score(PCIS).coagulation index(INR,APTT,PT,Plt,Fib),acid-base electrolyte index(Ca2+,Na+.K+,HCO3-,pH),liver and kidney function index(ALT,Tbil,Cr,BUN)were recorded before and after treatment,as well as prognosis(improvement,death,abandonment)and complications.Results:There were 92 children in the CVVH group,28 in the CVVH group,of which 14 were treated with regional citrate anticoagulation,14 with heparin anticoagulation,64 with CVVHDF group,15 with regional citrate anticoagulation,49 with heparin anticoagulation.There was no significant difference in age,sex composition,weight,pre-treatment PCIS,PICU stay time and total hospitalization time between the two groups.In CVVH mode,coagulation index(INR,PT,Fib,Plt),acid-base electrolyte index(pH,Na+,K+,Ca 2+,HCO3-),liver function(ALT)and PCIS after treatment had no difference between the two groups(P>0.05);The APTT in B group was longer than that before treatment(P<0.05);There was no significant change in APTT before and after treatment in A group(P>0.05);BUN and Tbil decreased after treatment in B group(P<0.05),and there was no significant change in BUN and Tbil after treatment in A group(P>0.05);The Cr after treatment was lower than that before treatment(P<0.05),but creatinine between the two groups had no difference(P>0.05).The median filter life of the B group was longer than that of A group(P<0.05);there was no difference in the duration of CBP treatment,bleeding,metabolic complications and hypocalcemia,and mortality.In CVVHDF mode,coagulation function(INR,PT,Fib)and K+between the two groups after treatment had no difference(P>0.05).APTT after treatment in B group was prolonged(P<0.05),APTT before and after treatment in A group had no difference(P>0.05);Plt after treatment in B group was lower than before(P<0.05),but no change in A group(P>0.05);pH,Na+,HCO3-in B group after treatment were higher than before(P<0.05);The Ca2+levels after treatment were higher than before in both groups(P<0.05);there was no difference in filter life,duration of CBP treatment,metabolic complications,incidence of hypocalcemia and mortality between the two groups(P>0.05);The bleeding complications of A group were less than those of B group(P<0.05).Conclusions:1.Regional citrate anticoagulation has less effect on coagulation function,less complications of bleeding and hypocalcemia in critically ill children under different treatment modes of continuous blood purification.,and is superior to heparin anticoagulation in safety.2.The duration of CRRT in regional citrate anticoagulation group had no obvious advantage in filter life.3.Regional citrate anticoagulation has little effect on liver function and does not aggravate liver function damage.It can be used in children with abnormal liver function.