Because existing anticoagulants may have contraindications and side effects, continuous renal replacement therapy (CRRT) without anticoagulants is nevertheless widely used. Although it does not produce major adverse effects without anticoagulant CRRT, it can raise the risk of clotting, which can lead to treatment cessation. Extracorporeal circulation lines with saline flush are frequently utilized as a non-pharmaceutical anticoagulation strategy. However, in the absence of anticoagulant CRRT, its clinical efficacy remains debatable. Therefore, this article reviews the specific procedures, flushing frequency, flushing effect, and adverse events of flushing extracorporeal circulation lines with normal saline when CRRT is free anticoagulant, generating fresh ideas for future research.
Objective To investigate the effectiveness of portable bracket of lower limb in the reconstruction of anterior cruciate l igament (ACL) by the long fibular muscle tendon under arthroscopy. Methods Between March 2008 and September 2010, 22 patients with ACL injury were treated. The limb position was maintained by portable bracket of lower limb and ACL was reconstructed with the long fibular muscle tendon under arthroscopy. There were 15 males and 7 females with an average age of 33.8 years (range, 19-64 years). The causes of ACL injury were traffic accident injury in 14 cases, sport trauma in 5 cases, and fall ing injury in 3 cases. The locations were the left knee in 10 cases and the right knee in12 cases, including 12 fresh injuries and 10 old injuries. Of 22 patients, 17 had positive anterior drawer test, 19 had positive pivot shift test, and 20 had positive Lachman test. According to International Knee Documentation Committee (IKDC) criteria, there were 6 abnormal and 16 severely abnormal. The subjective IKDC score was 57.64 ± 6.11. The Lysholm score was 55.45 ± 4.37. Results All incisions healed by first intention, and no complication was found. All patients were followed up 9-38 months (mean, 15 months). At last follow-up, the flexion of the knee ranged from 120 to 135° (mean, 127°). One patient had positive anterior drawer test, 1 patient had positive pivot shift test, and 2 patients had positive Lachman test. No ligament loosening and breakage occurred. According to the IKDC criteria, 10 patients rated as normal, 11 patients as nearly normal, and 1 patient as abnormal. The subjective IKDC score was 90.44 ± 6.11, showing significant difference when compared with preoperative one (t=4.653, P=0.021). The Lysholm score was 90.12 ± 5.78, showing significant difference when compared with preoperative one (t=4.231, P=0.028). Conclusion Portable bracket of lower limb in the reconstruction of ACL has the advantages of saving manpower and easy operation. The long fibular muscle tendon is enough long and b to reconstruct the ACL, which can increase the contact surface between the tendon and bone and is beneficial to tendon-bone heal ing.
Objective To evaluate the safety and efficacy of simplified regional citrate anticoagulation in sustained low efficiency dialysis (SLED). Methods We prospectively analyzed the patients with acute kidney injury or end stage renal disease in Department of Nephrology, West China Hospital of Sichuan University from March 2017 to May 2018. All the patients received SLED treatment by Fresenius 4008s ARrTplus through either femoral or internal jugular venous catheter, with each session of SLED treatment lasting for 8 to 10 hours. We pumped in 4% tri-sodium citrate solution through the arterial line at 300 mL/h and citrate infusion was stopped 15 minutes before ending of treatment. The blood flow was 150 mL/min while the calcium-containing dialysate (Ca 1.25 mmol/L) was delivered at 200 mL/min. We recorded peripheral, post filter ionized calcium level, and systemic citrate concentration at 0, 2 and 6 hours, respectively. Results Sixty-two patients underwent 185 sessions of SLED. Three sessions of two patients were discontinued for filter clotting, while the rest 182 SLED sessions (98.4%) were all successfully completed. The systemic citrate concentrations at 2 and 6 hours after beginning were of no statistical difference [(0.82±0.31) vs. (0.86±0.31) mmol/L, P=0.21]. The 0-, 2-, 6-hour peripheral blood ionized calcium levels were (1.12±0.21), (1.09±0.12), and (1.11±0.09) mmol/L, respectively, with no significant difference (P>0.05), and post filter ionized calcium at 2 and 6 hours after beginning were recorded as (0.35±0.06) and (0.31±0.04) mmol/L. The trans-membrane pressure at 2 and 6 hours after beginning were (106.2±13.8) and (105.3±22.4) mm Hg (1 mm Hg=0.133 kPa), with no significant difference (P=0.42). At 6 hours after beginning, prothrombin time and activated partial thrombin time were identified to be similar to those before SLED. During SLED treatments, in 4 sessions (2.2%), patients suffered mild metabolic alkalosis, but all of them recovered 4 hours later by themselves. No bleeding complication, thrombocytopenia, cardiac arrhythmia, hypernatremia, metabolic alkalosis or hypotension was observed. Conclusion SLED under simplified citrate anticoagulation is safe and effective by using calcium containing dialysate, which achieves satisfying regional anticoagulation effect without interfering systemic clotting function, and provides a new option of anticoagulation for SLED.
ObjectiveTo explore the application effect of information-based circuit teaching mode for training refresher nurses in continuous renal replacement therapy (CRRT).MethodsCRRT refresher nurses studied in West China Hospital of Sichuan University from January 2016 to December 2019 were selected. The CRRT refresher nurses who were selected as the control group (studied from January 2016 to December 2017) accepted the conventional teaching method. The CRRT refresher nurses who were selected as the test group (studied from January 2018 to December 2019) accept the information-based combined with circuit teaching mode for teaching and training. After 6 months of training, the theoretical performance, operation performance, teaching satisfaction and the incidence of adverse events were compared between the two groups.ResultsA total of 112 CRRT refresher nurses were enrolled. Among them, there were 52 nurses in the control group and 60 in the test group. The scores of theory achievement (t=−2.421, P=0.017), operation achievement (t=−2.305, P=0.023) and teaching satisfaction [including teaching effect (t=−4.067, P<0.001), operation skill (t=−5.013, P<0.001), teaching mode (t=−5.589, P<0.001) and teaching content (t=−2.586, P<0.001)] of refresher nurses in the test group were higher than those in the control group. There was no significant difference between the control group (4 cases) and the test group (1 case) in the occurrence of adverse nursing events (adjusted χ2=1.169, P=0.280).ConclusionThe information-based circuit teaching mode has achieved good results in the teaching of CRRT refresher nurses, which is conducive to improving the post competency of CRRT refresher nurses.
Objective To explore the application of regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) for patients with sepsis and hyperlactacidemia, and to provide a basis for the clinical application of RCA in such patients. Methods Sepsis patients who underwent RCA-CRRT at West China Hospital of Sichuan University between May 2021 and May 2023 were retrospectively included. Patients were divided into a normal lactate group (≤2.0 mmol/L) and a hyperlactacidemia group (>2.0 mmol/L) based on their initial lactate levels before CRRT, and subgroup analysis was performed on patients with moderate hyperlactacidemia (2 mmol/L<lactate level<4 mmol/L) and severe hyperlactacidemia (≥4.0 mmol/L). Propensity score matching (PSM) was used, and baseline characteristics and outcome measures of different groups of patients were compared. Results A total of 441 patients were included, with 228 in the normal lactate group and 213 in the hyperlactacidemia group. Before PSM, there were statistically significant differences in the proportion of liver failure, proportion of chronic kidney disease, mean arterial pressure, bicarbonate, total bilirubin, creatinine, activated partial thromboplastin time, international standardized ratio, procalcitonin, and interleukin-6 between the normal lactate group and the hyperlactacidemia group (P<0.05). After PSM, there were 162 patients in both the normal lactate group and the hyperlactacidemia group. There was no statistically significant difference in baseline characteristics between the two groups of patients (P>0.05). The incidence of citric acid accumulation in the normal lactate group and the hyperlactacidemia group was 13.0% and 25.9%, respectively (P<0.05). There was no statistically significant difference in the incidence of metabolic acidosis, metabolic alkalosis, hypernatremia, filter coagulation events, or in-hospital mortality between the two groups (P>0.05). Kaplan-Meier survival analysis showed that there was no statistically significant difference in the first extracorporeal circulation lifespan between the normal lactate group and the hyperlactacidemia group (P>0.05). Among 213 patients with hyperlactacidemia, 186 had moderate hyperlactacidemia and 27 had severe hyperlactacidemia. Before PSM, there were statistically significant differences in the proportion of male, proportion of diabetes, albumin level, international standardized ratio, and interleukin-6 between moderate and severe hyperlactacidemia groups (P<0.05). After PSM, there were 22 patients in both the moderate and severe hyperlactacidemia groups. There was no statistically significant difference in baseline characteristics between the two groups of patients (P>0.05). The incidence of citric acid accumulation was 18.2% and 50.0% in the moderate and severe hyperlactacidemia groups, respectively (P<0.05). There was no statistically significant difference in the incidence of metabolic acidosis, metabolic alkalosis, hypernatremia, filter coagulation events, or in-hospital mortality between the two groups (P>0.05). Kaplan-Meier survival analysis showed that there was no statistically significant difference in the first extracorporeal circulation lifespan between the moderate and severe hyperlactacidemia groups (P>0.05). Conclusion When RCA is used for CRRT anticoagulation in patients with sepsis and hyperlactacidemia, the incidence of citric acid accumulation is high (especially in patients with severe hyperlactacidemia), and should be closely monitored.
Objective To evaluate and compare the outcomes of simple closed reduction, selective fragment excision after closed reduction, and emergency fragment excision and reduction in the treatment of Pipkin type I fracture of femoral head associated with posterior dislocation of the hip. Methods Between January 2002 and January 2008, 24 patients with Pipkin type I fracture of the femoral head associated with posterior dislocation of the hip were treated with simple closed reduction (closed reduction group, n=8), with selective fragment excision after closed reduction (selective operation group, n=8), and with emergency fragment excision and reduction (emergency operation group, n=8). In the closed reduction group, there were 6 males and 2 females with an average age of 37.6 years (range, 19-56 years); injuries were caused by traffic accident in 6 cases, by fall ing from height in 1 case, and by crushing in 1 case with a mean disease duration of 3.1 hours (range, 1.0-7.5 hours); and the interval from injury to reduction was (4.00 ± 2.14) hours. In the selective operation group, there were 7 males and 1 female with an average age of 37.3 years (range, 21-59 years); injuries were caused by traffic accident in 7 cases and by fall ing from height in 1 case with a mean disease duration of 3.2 hours (range, 1.0-6.0 hours); and the interval from injury to reduction was (3.90 ± 1.47) hours. In the emergency operation group, there were 5 males and 3 females with an average age of 35.5 years (range, 20-58 years); injuries were caused by traffic accident in 5 cases, by fall ing from height in 1 case, and by crushing in 2 cases with a mean disease duration of 3.3 hours (range, 1.5-6.5 hours); and the interval from injury to open reduction was (5.10 ± 2.04) hours. There was no significant difference in the age, gender, disease duration, and interval from injury to reduction among 3 groups (P gt; 0.05). Results All wounds in selective operation group and emergency operation group healed primarily. All the patients were followed up 24 to 58 months (mean, 38.7 months). According to Thompson-Epstein system, the excellent and good rates were 50.0% (4/8) in the closed reduction group, 87.5% (7/8) in the selective operation group, and 87.5% (7/8) in the emergency operation group at 24 months after operation, showing significant difference among 3 groups (χ2=9.803, P=0.020). Heterotopic ossification was found in 1 case (12.5%) of the closed reduction group, in 4 cases (50.0%) of the selective operation group, and in 4 cases (50.0%) of the emergency operation group, and avascular necrosis of femoral head was found in 2 cases (25.0%) of the closed reduction group; there was no significant difference in compl ications among 3 groups (P gt; 0.05). Conclusion The treatment of Smith-Petersen approach and fragment excision by selective operation or emergency operation has similar outcome, which are better than the treatment of simple closed reduction.