【摘要】体外循环抗凝是连续性肾脏替代治疗(continuerenal replacement therapy,CRRT)顺利实施的重要环节，不合适的抗凝方案可导致患者体外循环凝血、血液丢失、血液高凝、血栓栓塞性疾病，严重者可危及生命。局部枸橼酸抗凝(regional citrate anticoagulation，RCA)由于具有抗凝效果确切、出血风险小等优势，在CRRT 中广泛应用，特别适用于合并高出血风险疾病的患者，但目前在临床上应用方案尚无统一标准。本文就CRRT 中应用RCA 的技术要点和相关注意事项进行简要介绍，以便更好地指导临床应用。
【Abstract】Anticoagulation in extracorporeal circulation is an important step for successful implementation of continuous renal replacement therapy (CRRT). Inappropriate anticoagulation regimen will cause blood coagulation in extracorporeal circulation, blood loss, hypercoagulation status or thromboembolic diseases, which are life-threatening in severe cases. Regional citrate anticoagulation (RCA) with its advantages of effective anticoagulation and lower bleeding risk is widely used in CRRT, especially for patients with bleeding risk. However, there are no standard protocols yet for clinical application. This article briefly introduces the
technical essentials and precautions of RCA for its better use in CRRT.
[1]Kidney Disease Improving Global Outcome KDIGO.Acute kidney injury work group:KDIGO linical practice guideline for acute kidney injury[J].Kidney Int, 2012, 2(Suppl):1-138
[2]Zhang Z, Hongying N.Efficacy and safety of regional citrate anticoagulation in critically ill patients undergoing continuous renal replacement therapy[J].Intensive Care Med, 2012, 38(1):20-28
[3]Bai M, Zhou M, He L, et al.Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs[J].Intensive Care Med, 2015, 41(12):2098-2110
[4]Rogers AR, Jenkins B.Calorie provision from citrate anticoagulation in continuous renal replacement therapy in critical care[J].J Intensive Care Soc, 2021, 22(3):183-186
[5]Khadzhynov D, Schelter C, Lieker I, et al.Incidence and outcome of metabolic disarrang-ements consistent with citrate accumulation in critically ill patients undergo-ing continuous venovenous hemodialysis with regional citrate anticoagulation[J].J Crit Care, 2014, 29(2):265-271
[6]Hetzel GR, Taskaya G, Sucker C, et al.Citrate plasma levels in patients under regionala?nticoagulation in continuous venovenous hemofiltration[J].Am J Kidney Dis, 2006, 48(5):806-811
[7]Meier-Kriesche HU, Gitomer J, Finkel K, et al.Increased total to ionized calcium ratio d-uring continuous venovenous hemodialysis with regional citrate anticoagulation[J].Crit Care Med, 2001, 29(4):748-752
[8]Schulthei? C, Saugel B, Phillip V, et al.Continuous venovenous hemodialysis with regional citrate anticoagulation in patients with liver failure: a prospective observational study[J].Crit Care, 2012, 16(4):R162-
[9]Schwarzer P, Kuhn SO, Stracke S, et al.Discrepant post filter ionized calcium concentrations by common blood gas analyzers in CRRT using regional citrate antico-agulation[J].Crit Care, 2015, 19(1):321-
[10]Mariano F, Morselli M, Bergamo D, et al.Blood and ultrafiltrate dosage of citrate as a u?se?ful and routine tool during continuous venovenous haemodiafiltration in septic shock patients[J].Nephrol Dial Transplant, 2011, 26(12):3882-3888
[11]Rêgo F Portela F, Santos MF.Towards PWA in Healthcare[J].Proced Computer Sci, 2019, 160:678-683
[12]Szamosfalvi B, Heung M, Yessayan L.Technology Innovations in Continuous Kidney Replacement Therapy: The Clinician's Perspective[J].Adv Chronic Kidney Dis, 2021, 28(1):3-12
[13]龚德华, 季大玺, 徐斌, 等.枸橼酸钠抗凝在重危患者连续性血液净化治疗中的应用[J].中华内科杂志, 2003, 42(02):121-122
[14]Zhao Y, Li Z, Zhang L, et al.Citrate versus heparin lock for hemodialysis catheters: a s-ystematic review and meta-analysis of randomized controlled trials[J].Am J Kidney Dis, 2014, 63(3):479-490
[15]Potier J, Dolley-Hitze T, Hamel D, et al.Long-term effects of citric acid-based bicarbonate haemodialysis on patient outcomes: a survival propensity score-matched study in western France[J].Nephrol Dial Transplant, 2020, 35(7):1228-1236
[16]Wen M, Küchle C, Steubl D, et al.A novel citrate-based protocol versus heparin anticoa-gultion for sustained low-efficiency dialysis in the ICU: safety,efficacy,and cost[J].BMC Nephrol, 2018, 19(1):79-
[17]Kissling S, Legallais C, Pruijm M, et al.A new prescription model for regional citrate anticoagulation in therapeutic plasma exchanges[J].BMC Nephrol, 2017, 18(1):81-
[18]Ponikvar R, Guben?ek J, Ponikvar JB.Citrate Anticoagulation in Tandem Membrane Plasma Exchange or Immunoadsorption and Hemodialysis in Patients With Immuno-logical Diseases and Dialysis-Dependence[J].Ther Apher Dial, 2016, 20(3):246-250
