Comparing The Safety And Efficiency Of Two Different Anticoagulants In Continuous Renal Replacement Therapy To Critically Ⅲ Patients

Objective:Continuous renal replacement therapy has become the standard of care for patients in intensive care unit. Whether the therapy can be carried out smoothly depends on the anticoagulants’ effect of extracorporeal circuit. Anticoagulants’ effect is also the key issue if the illness can be controlled in time and medical procedures can be done orderly. The aim of the current study is to evaluate the efficacy and safety of different anticoagulants used in continuous renal replacement therapy:heparin versus citrate. Methods:The patients involved in this study were choosen from Intensive Care Uint of Dong Guan Cardiovascular and Cerebrovascular Disease Specialist Ward of Yan’an University affiliated hospital, and were divided into heparin group and citrate group in line with different anticoagulants. We chose twenty patients for heparin group and twenty patients for citrate group according to Inclusion Criteria and Exclusion Criteria. They all used continuous veno-venous hemofiltration(CVVH) model, and the vascular accesses of which used 8G 20 cm double lumen central venous catheter inserted through femoral veins. PRISMA FLEX hemofiltration apparatus and AN69 filter(M100 Membrane area of 0.9m2) were applied into CRRT, with the displacement liquid of 3000ml/h, pre-displacement of 100%, and blood flow rate of 100-200ml/min. Filters and catheters were pre rinsed with 2L physiological saline which contained 12500 units of heparin sodium before the start of hemofiltration, and the pre rinsing liquid which contained heparin sodium was released when the blood was led.Heparin group(Group A): The heparin load was 30 IU/kg, then a dose of 10 IU/kg/h was continuously pumped into.Citrate group(Group B): This study used 4% sodium citrate. The initial pump speed(ml/h) of 4% sodium citrate was set 1.2 times of blood flow rate, and the pump speed of 10% calcium gluconate was 7.3% of that of citrate. The dose of citrate was adjusted according to the concentration of calcium ions after the filter, while the dose of calcium gluconate was adjusted according to the calcium ions in vivo. The hematological indexes before and after CRRT, coagulation indexes, kidney functions, electrolytes, metabolic indexes and the filter lifespans were monitored, and the efficacy and safety of anticoagulation were evaluated. Results:20 patients were included into this study, of which there were 20 patients in Group A, and 20 patients in Group B, before the CRRT, there was no obvious statistical significance in gender, ages, weights and APACHEII scores of the two groups(P>0.05). Before the CRRT, a comparison of white blood cells(WBC), hemoglobin(HB), platelet count(PLT), coagulation functions, renal functions and electrolytes between the two groups were made, and there was no obvious statistical significance(P>0.05). Both in Group A and Group B, there was a decrease in WBC、HB and PLT after the treatment than before(P<0.05), the activated partial thromboplastin time(APTT) was prolonged after the treatment than before in Group A(P<0.05), while there were no significant changes in APTT before and after the treatment in Group B(P>0.05). The BUN and Cr of both two groups of patients significantly decreased than before(P<0.05), The reduced volume of BUN has statistically significance in the comparisons of both two groups, while there was no statistically significance in the comparisons of reduced velume of Cr. There was obvious statistically significance in electrolytes before and after treatment of the two groups. In Group B, there was no statistically significance in the comparisons of ionized calcium within each group or between the two groups of patients at each time point(P>0.05), while between the two groups of patients at each time point there were significant differences(P<0.05). There was significant differences between the blood gas indexes(P<0.05). The filter lifespans(mean±standard deviation) were respectively as Group A of 13.9±4.69 h, Group B of 30.2±7.90 h, which proved that the filter lifespans of citrate group was longer than that of heparin group, the P value after the comparison between the two groups was 0.047(P>0.05), there were obvious statistical differences. Conclusion:1. The filter life of citrate group is obviously longer than that of heparin group, and the efficacy of citrate is superior to heparin.2.The activated partial thromboplastin time(APTT) was prolonged in heparin group, while there was no difference in citrate group. There was no statistically significance in the incidence of bleeding, thus the citrate has more advantages in safety.3.Citrate group was superior to heparin group on kidney functions’ recovery.