Application Of Optimized Regional Citrate Anticoagulant Protocol In Continuous Renal Replacement Therapy

Objective:To compare the advantages and disadvantages of traditional regional citrate anticoagulation and optimized regional citrate anticoagulation in CRRT.Methods:Selected 100 patients with CRRT indications and citrate anticoagulation in Jinniu People’s Hospital of Chengdu from January 2020 to December 2021.Divided them into a control group and an experimental group with 50 cases in each group.The control group with a traditional regional citrate anticoagulation regimen and the experimental group used the citric acid dose calculated by the parameter model formula as the initial citric acid dose.Used the same monitoring and adjustment methods during the treatment.Recorded the gender,age,basic diseases,hemoglobin（HGB）,platelet（PLT）,hematocrit（HCT）,aspartate aminotransferase（AST）,alanine aminotransferase（ALT）,albumin（ALB）,total bilirubin（TBIL）,blood urea nitrogen（BUN）,serum creatinine（Scr）,partial thromboplastin time（APTT）,thrombin time（TT）,coagulation position,coagulation degree of filter,ultrafiltration volume,adverse events,citric acid adjustment times and blood gas analysis Ca²⁺level before and after treatment in the two groups.Compared the safety,efficacy and simplicity of the two groups.Results:There was no significant differences in gender and age between the two groups（P>0.05）.The proportion of diabetes mellitus in experimental group was higher than that in control group（13 cases vs 23 cases,P<0.05）.Compared with control group,PLT level was slightly increased（136.68±75.79 vs 171.16±69.09,P<0.05）,APTT and AST levels were decreased（32.80 vs 28.39;81.16 vs 72.70,all P<0.05）,while HGB,HCT,TT,TBIL,ALB,BUN and Scr levels were not significantly changed,and the differences were not statistically significant（73.96 vs 69.00;31.45±5.52 vs 30.70±7.99;17.50±9.62 vs 16.07±14.58;272.48 vs 281.76,P>0.05）;The overall dialysis time was increased（12.34±3.20 vs 16.78±7.65,P<0.05）,initial citrate dose was increased（226.8 vs 246.1,P<0.01）,and the number of dialysis regimen adjustments and filter coagulation were reduced（4.76 vs 3.14;28 vs 13,P<0.05）,the difference was statistically significant compared with the control group.In the test group,the frequency of coagulation grade 3 or above was less（10 cases vs 2 cases,P<0.05）,and the frequency of premature termination of treatment due to coagulation of venous chamber or filter was less（8 cases vs 1case,P<0.05）,and the frequency of premature termination of treatment due to hypotension did not change significantly（4 cases vs 3 cases,P>0.05）.In the comparison of blood gas analysis and adverse events,there was no significant change in Ca2+level in the two groups within the treatment cycle,and the difference had no statistical significance（1.02±0.10 vs 1.04±0.07;1.03±0.11 vs 1.04±0.07,P>0.05）;23 cases in the control group had electrolyte imbalance,8 cases in the test group had electrolyte imbalance,and the difference had statistical significance（P<0.01）;1 case in the control group had acid-base imbalance,and no acid-base imbalance occurred in the test group.Conclusion:This paper proposes an optimized citrate anticoagulation protocol,which can calculate the individualized initial citrate dose,initiating CRRT treatment by the prediction formula,before CRRT treatment.Compared with the initial citrate dose calculated based on blood flow by the traditional regional citrate protocol,it can increase the CRRT treatment time of patients,increase the filter’s survival time,reduce the occurrence of adverse events such as coagulation,and reduce repeated adjustments of parameters during treatment.This protocol is worthy of promotion in clinical practice.