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：

局部枸橼酸抗凝; CRRT; 挤压综合征

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目的:分析局部枸橼酸抗凝在地震挤压伤患者CRRT治疗中的效果和安全性,并比较不同实施方式的差异。方法:回顾性的分析汶川地震后我院收治的因挤压伤而接受CRRT治疗的患者中局部枸橼酸抗凝的情况。共计39例患者因挤压伤和多器官功能障碍而接受局部枸橼酸抗凝CRRT治疗。按照不同的实施方式分为A组(23例)以同步输入方式进行,B组(16例)以预充式进行。治疗过程中监测患者的肝肾功能、电解质、凝血指标、血常规等。分析不同治疗组局部枸橼酸抗凝治疗的效果和安全性。结果:39例患者死亡4例,其余35例均康复。存活患者治疗后SCr和BUN指标均较治疗前明显降低,差异有统计学意义,Scr:A组(503±215)μmol/L对(149±129.7)μmol/L,B组(577±227)μmol/L对(180.6±146.5)μmol/L,P lt;0.05;BUN:A组(26.6±10.4) mmol/L对(9.3±6.9)mmol/L,B组(30.5±8.1)mmol/L对(10.9±5.72)mmol/L,P lt;0.05。两组滤器后ACT值均较外周血ACT值明显延长且差异有统计学意义,A组:(161±31) s 对 (122±25)s,B组:(157±33)s 对 (125±31) s,P lt;0.05。A组滤器和管路寿命(47.6±11.2)h与B组(41.3±14.5)h相近,A组略长于B组,但两组差异无统计学意义(P gt;0.05)。其他凝血指标差异无统计学意义。在治疗过程中未发生严重电解质和酸碱平衡紊乱。结论:局部枸橼酸抗凝适于地震挤压伤患者CRRT治疗,这种抗凝方式抗凝效果确切,而且不会加重患者的凝血功能紊乱,不会增加患者活动性出血的风险。同步式局部枸橼酸抗凝在延长滤器和管路方法可能优于预充方式

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

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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..
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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. 龚德华, 季大玺, 徐斌. 在严重出血倾向重危患者应用枸橼酸抗凝进行连续性静脉静脉血液滤过治疗[J]. 肾脏病与透析肾移植杂志, 2002,11(6):510-514..
5. 苏白海, 秦伟, 付平. 预冲式枸橼酸钠抗凝技术在连续性血液净化高危出血患者中的应用[J]. 西部医学, 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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