Clinical Observation of Local Citrate Anticoagulation in Crush Syndrome Patients Undergoing CRRT after Earthquake_West China Medical Journal

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Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu 610041, China;

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Keywords：

局部枸櫞酸抗凝; CRRT; 擠壓綜合征

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目的:分析局部枸櫞酸抗凝在地震擠壓傷患者CRRT治療中的效果和安全性,并比較不同實施方式的差異。方法:回顧性的分析汶川地震后我院收治的因擠壓傷而接受CRRT治療的患者中局部枸櫞酸抗凝的情況。共計39例患者因擠壓傷和多器官功能障礙而接受局部枸櫞酸抗凝CRRT治療。按照不同的實施方式分為A組(23例)以同步輸入方式進行,B組(16例)以預充式進行。治療過程中監測患者的肝腎功能、電解質、凝血指標、血常規等。分析不同治療組局部枸櫞酸抗凝治療的效果和安全性。結果:39例患者死亡4例,其余35例均康復。存活患者治療后SCr和BUN指標均較治療前明顯降低,差異有統計學意義,Scr:A組(503±215)μmol/L對(149±129.7)μmol/L,B組(577±227)μmol/L對(180.6±146.5)μmol/L,P lt;0.05;BUN:A組(26.6±10.4) mmol/L對(9.3±6.9)mmol/L,B組(30.5±8.1)mmol/L對(10.9±5.72)mmol/L,P lt;0.05。兩組濾器后ACT值均較外周血ACT值明顯延長且差異有統計學意義,A組:(161±31) s 對 (122±25)s,B組:(157±33)s 對 (125±31) s,P lt;0.05。A組濾器和管路壽命(47.6±11.2)h與B組(41.3±14.5)h相近,A組略長于B組,但兩組差異無統計學意義(P gt;0.05)。其他凝血指標差異無統計學意義。在治療過程中未發生嚴重電解質和酸堿平衡紊亂。結論:局部枸櫞酸抗凝適于地震擠壓傷患者CRRT治療,這種抗凝方式抗凝效果確切,而且不會加重患者的凝血功能紊亂,不會增加患者活動性出血的風險。同步式局部枸櫞酸抗凝在延長濾器和管路方法可能優于預充方式

Citation： QIN Wei,SU Baihai,FU Ping,et al.. Clinical Observation of Local Citrate Anticoagulation in Crush Syndrome Patients Undergoing CRRT after Earthquake. West China Medical Journal, 2009, 24(7): 1808-1811. doi: Copy

1.	VANHOLDER R, et al. Earthquakes and crush syndrome casualties: lessons learned from the Kashmir disaster [J]. Kidney Int, 2007,71(1):17-23..
2.	ODA Y, et al. Crush syndrome sustained in the 1995 Kobe, Japan, earthquake; treatment and outcome[J]. Ann Emerg Med, 1997,30(4):507-512..
3.	KUTSOGIANNIS D J, et al.Regional citrate anticoagulation in continuous venovenous hemodiafiltration[J]. Am J Kidney Dis, 2000,35(5):802-811..
4.	龔德華, 季大璽, 徐斌. 在嚴重出血傾向重危患者應用枸櫞酸抗凝進行連續性靜脈靜脈血液濾過治療[J]. 腎臟病與透析腎移植雜志, 2002,11(6):510-514..
5.	蘇白海, 秦偉, 付平. 預沖式枸櫞酸鈉抗凝技術在連續性血液凈化高危出血患者中的應用[J]. 西部醫學, 2008,20(2):267-270..
6.	PALSSON R, JL. Niles, Regional citrate anticoagulation in continuous venovenous hemofiltration in critically ill patients with a high risk of bleeding[J]. Kidney Int, 1999,55(5):1991-1997..
7.	SCHMITZ M, et al.Continuous venovenous haemofiltration using a citrate buffered substitution fluid[J]. Anaesth Intensive Care, 2007,35(4):529-535..

1. VANHOLDER R, et al. Earthquakes and crush syndrome casualties: lessons learned from the Kashmir disaster [J]. Kidney Int, 2007,71(1):17-23..
2. ODA Y, et al. Crush syndrome sustained in the 1995 Kobe, Japan, earthquake; treatment and outcome[J]. Ann Emerg Med, 1997,30(4):507-512..
3. KUTSOGIANNIS D J, et al.Regional citrate anticoagulation in continuous venovenous hemodiafiltration[J]. Am J Kidney Dis, 2000,35(5):802-811..
4. 龔德華, 季大璽, 徐斌. 在嚴重出血傾向重危患者應用枸櫞酸抗凝進行連續性靜脈靜脈血液濾過治療[J]. 腎臟病與透析腎移植雜志, 2002,11(6):510-514..
5. 蘇白海, 秦偉, 付平. 預沖式枸櫞酸鈉抗凝技術在連續性血液凈化高危出血患者中的應用[J]. 西部醫學, 2008,20(2):267-270..
6. PALSSON R, JL. Niles, Regional citrate anticoagulation in continuous venovenous hemofiltration in critically ill patients with a high risk of bleeding[J]. Kidney Int, 1999,55(5):1991-1997..
7. SCHMITZ M, et al.Continuous venovenous haemofiltration using a citrate buffered substitution fluid[J]. Anaesth Intensive Care, 2007,35(4):529-535..

West China Medical Journal

Clinical Observation of Local Citrate Anticoagulation in Crush Syndrome Patients Undergoing CRRT after Earthquake

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