Email Alerts
RSS
Volume 38 Issue 1
Jan.  2022
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2022  >  38(1): 29-37
Li Ning,Chen Hualing,Li Maojun,et al.Application effects of bundle nursing of citric acid extracorporeal anticoagulation on continuous renal replacement therapy of severe burn patients[J].Chin J Burns Wounds,2022,38(01):29-37.DOI: 10.3760/cma.j.cn501120-20201201-00511.
Citation: Li Ning,Chen Hualing,Li Maojun,et al.Application effects of bundle nursing of citric acid extracorporeal anticoagulation on continuous renal replacement therapy of severe burn patients[J].Chin J Burns Wounds,2022,38(01):29-37.DOI: 10.3760/cma.j.cn501120-20201201-00511.
shu

Application effects of bundle nursing of citric acid extracorporeal anticoagulation on continuous renal replacement therapy of severe burn patients

doi: 10.3760/cma.j.cn501120-20201201-00511

  • State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China

More Information
  • Corresponding author: Yuan Zhiqiang, Email: cqburn@aliyun.com
  • Received Date: 2020-12-01
    Abstract
  •   Objective   To explore the application effects of bundle nursing of citric acid extracorporeal anticoagulation on continuous renal replacement therapy (CRRT) of severe burn patients.   Methods   A non-randomized controlled study was conducted. Forty-six patients who met the inclusion criteria and received regular nursing of citric acid extracorporeal anticoagulation during CRRT in the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from January to December 2017 were included in regular nursing group (30 males and 16 females, aged 42.0 (38.7,47.0) years, with 201 times of CRRT performed), and 48 patients who met the inclusion criteria and received bundle nursing of citric acid extracorporeal anticoagulation during CRRT in the same hospital from January to December 2018 were included in bundle nursing group (32 males and 16 females, aged 41.0 (36.0,46.0) years, with 164 times of CRRT performed). The clinical data of all the patients in the two groups were recorded, including the length of intensive care unit (ICU) stay, total cost of treatment in ICU, cost of CRRT, unplanned ending of treatment, ending of treatment due to operation (with the rates of unplanned ending of treatment and ending of treatment due to operation calculated), times of disposable hemodialysis filter and supporting pipeline filter (hereinafter referred to as filter) with use time>24 h, times of CRRT, and lifetime of filter. For the patients in both groups who continuously received CRRT for 3 days or more from the first treatment, the prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), total calcium, ionic calcium (with the difference of total calcium or ionic calcium between before and after treatment calculated), creatinine, urea, β 2 microglobulin, cystatin C, platelet count, mean arterial pressure, pH value, oxygenation index, bicarbonate radical, and lactic acid levels before the first treatment (hereinafter referred to as before treatment) and 3 days after the first treatment (hereinafter referred to as after 3 days of treatment). The treatment-related complications of all patients in the two groups were recorded during hospitalization. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test.   Results   Compared with those in regular nursing group, the length of ICU stay was significantly shortened ( Z=-4.71, P<0.01), the total cost of treatment in ICU was significantly reduced ( t=-1.39, P<0.01), the cost of CRRT had no significant change ( P>0.05), the rates of unplanned ending of treatment and ending of treatment due to operation were both significantly decreased (with χ 2 values of 12.20 and 17.83, respectively, P<0.01), the times of filter service time>24 h was increased significantly ( Z=-5.93, P<0.01), the times of CRRT were significantly reduced ( Z=-4.75, P<0.01), and the filter service life was significantly prolonged ( Z=-9.24, P<0.01) among patients in bundle nursing group. Thirty-one patients in bundle nursing group and 28 patients in regular nursing group continuously received CRRT for 3 days or more from the first treatment. Before treatment, PT, APTT, and INR of patients in bundle nursing group were 24.10 (16.08, 39.20) s, 38.81 (32.32, 45.50) s, and 1.17 (1.12, 1.19), respectively, similar to 31.75 (22.99, 40.96) s, 41.82 (35.05, 48.06) s, and 1.15 (1.11, 1.19) of patients in regular nursing group ( P>0.05); the levels of total calcium and ionic calcium of patients in the two groups were similar ( P>0.05). After 3 days of treatment, PT, APTT, and INR of patients in bundle nursing group and regular nursing group were 29.06 (20.11, 39.46) s, 35.25 (30.06, 40.28) s, 1.13 (1.09, 1.17) and 36.51 (26.64, 42.92) s, 39.89 (34.81, 46.62) s, 1.14 (1.10, 1.18), respectively, similar to those before treatment ( P>0.05); the level of ionic calcium of patients in regular nursing group was significantly higher than that before treatment ( Z=-2.08, P<0.05); the levels of total calcium and ionic calcium of patients in bundle nursing group were both significantly higher than those before treatment (with Z values of -3.55 and -3.69, respectively, P<0.01); compared with those in regular nursing group, APTT of patients was significantly shorter ( Z=-2.29, P<0.05), while the total calcium level of patients was significantly higher in bundle nursing group ( Z=-2.26, P<0.05). The difference of total calcium between before and after treatment of patients in bundle nursing group was significantly higher than that in regular nursing group ( Z=-3.15, P<0.01). The differences of ionic calcium between before and after treatment of patients in the two groups were similar ( P>0.05). Before treatment, the level of β 2microglobulin of patients in bundle nursing group was significantly higher than that in regular nursing group ( Z=-2.84, P<0.01), the platelet count of patients in bundle nursing group was significantly lower than that in regular nursing group ( Z=-2.44, P<0.05), while the levels of creatinine, urea, cystatin C, mean arterial pressure, pH value, oxygenation index, bicarbonate radical, and lactic acid of patients in the two groups were similar ( P>0.05). After 3 days of treatment, the levels of creatinine, urea, β 2 microglobulin, cystatin C, pH value, bicarbonate radical, and lactic acid of patients were all significantly lower than those before treatment (with Z values of -2.10, -2.90, -3.11, -2.02, -2.34, -2.63, and -2.84, respectively, P<0.05 or P<0.01), while the levels of platelet count, oxygenation index, and mean arterial pressure of patients were all significantly higher than those before treatment in bundle nursing group (with Z values of -6.65 and -2.40, respectively, t=-9.97, P<0.05 or P<0.01); the levels of creatinine, urea, β 2 microglobulin, cystatin C, platelet count, pH value, bicarbonate radical, and lactic acid of patients were all significantly lower than those before treatment (with Z values of -5.32, -2.31, -2.41, -2.21, -3.68, -2.93, -2.20, and -2.31, respectively, P<0.05 or P<0.01), while the oxygenation index and mean arterial pressure of patients were both significantly higher than those before treatment in regular nursing group ( Z=-5.59, t=-7.74, P<0.01). After 3 days of treatment, compared with those in regular nursing group, the levels of creatinine, cystatin C, platelet count, oxygenation index, bicarbonate radical, and mean arterial pressure of patients were all significantly higher (with Z values of -2.93, -1.99, -6.39, -2.09, and -2.52, respectively, t=-3.28, P<0.05 or P<0.01), while the levels of urea, β 2 microglobulin, pH value, and lactic acid of patients were all significantly lower (with Z values of -3.87, -2.58, -4.24, and -2.75, respectively, P<0.05 or P<0.01) in bundle nursing group. During hospitalization, there were no treatment-related bleeding events or hypernatremia related to citric acid treatment of patients in the two groups. The ratio of total calcium to ionic calcium in one patient in bundle nursing group was >2.5, but there was no manifestation of citric acid accumulation poisoning; 1 patient had hypoionic calcemia, and 1 patient had severe metabolic alkalosis. Five patients had hypoionic calcemia and 2 patients had severe metabolic alkalosis in regular nursing group.   Conclusions   The implementation of bundle nursing of citric acid extracorporeal anticoagulation during CRRT for severe burn patients shortens the length of ICU stay, reduces the total cost of treatment in ICU and the occurrence of treatment-related complications, relieves the economic burden of patients, and improves the continuity and quality of treatment.

     

    • FullText(HTML)
  • loading
    • References(37)
  • [1]
    龚德华,贾凤玉.重症烧伤患者救治中CRRT的应用[J].中国血液净化,2016,15(7):321-324.DOI: 10.3969/j.issn.1671-4091.2016.07.001.
    [2]
    刘峰, 黄正根, 彭毅志, 等. 严重烧伤早期行连续性血液净化治疗的可行性及疗效随机对照临床试验 [J] . 中华烧伤杂志,2016,32(3): 133-139. DOI: 10.3760/cma.j.issn.1009-2587.2016.03.002.
    [3]
    VincentJL,de MendonçaA,CantraineF,et al.Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine[J].Crit Care Med,1998,26(11):1793-1800.DOI: 10.1097/00003246-199811000-00016.
    [4]
    KnausWA,DraperEA,WagnerDP,et al.APACHE Ⅱ: a severity of disease classification system[J].Crit Care Med,1985,13(10):818-829.
    [5]
    LiH,WangS,TanJ,et al.Epidemiology of pediatric burns in southwest China from 2011 to 2015[J].Burns,2017,43(6):1306-1317.DOI: 10.1016/j.burns.2017.03.004.
    [6]
    KirwanCJ,HutchisonR,GhabinaS,et al.Implementation of a simplified regional citrate anticoagulation protocol for post-dilution continuous hemofiltration using a bicarbonate buffered, calcium containing replacement solution[J].Blood Purif,2016,42(4):349-355.DOI: 10.1159/000452755.
    [7]
    VinsonneauC,Allain-LaunayE,BlayauC,et al.Renal replacement therapy in adult and pediatric intensive care: recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD)[J].Ann Intensive Care,2015,5(1):58.DOI: 10.1186/s13613-015-0093-5.
    [8]
    SlowinskiT,MorgeraS,JoannidisM,et al.Safety and efficacy of regional citrate anticoagulation in continuous venovenous hemodialysis in the presence of liver failure: the Liver Citrate Anticoagulation Threshold (L-CAT) observational study[J].Crit Care,2015,19:349.DOI: 10.1186/s13054-015-1066-7.
    [9]
    KhadzhynovD,SchelterC,LiekerI,et al.Incidence and outcome of metabolic disarrangements consistent with citrate accumulation in critically ill patients undergoing continuous venovenous hemodialysis with regional citrate anticoagulation[J].J Crit Care,2014,29(2):265-271.DOI: 10.1016/j.jcrc.2013.10.015.
    [10]
    ZhangL,LiaoY,XiangJ,et al.Simplified regional citrate anticoagulation using a calcium-containing replacement solution for continuous venovenous hemofiltration[J].J Artif Organs,2013,16(2):185-192.DOI: 10.1007/s10047-012-0680-2.
    [11]
    许钟烨,丁峰.局部柠檬酸抗凝在连续性肾脏替代治疗中的应用进展[J].中国血液净化,2011,10(4):208-211.DOI: 10.3969/j.issn.1671-4091.2011.04.010.
    [12]
    杨洛,刁永书,陈志文,等.同步柠檬酸抗凝与无肝素抗凝在连续性血液净化中的应用及护理[J].西部医学,2012,24(2):391-393.D0I:10.3969/j.issn.1672-3511.2012.02.08.
    [13]
    杨莹.枸橼酸抗凝在连续性血液净化中的应用与护理进展[J].国际移植与血液净化杂志,2011,9(5):17-20.DOI: 10.3760/cma.j.issn.1673-4238.2011.05.004.
    [14]
    GongD,JiD,XuB,et al.Regional citrate anticoagulation in critically ill patients during continuous blood purification[J]. Chin Med J (Engl),2003,116(3):360-363.
    [15]
    LindenK,StewartIJ,KreyerSF,et al.Extracorporeal blood purification in burns: a review[J].Burns,2014,40(6):1071-1078.DOI: 10.1016/j.burns.2014.01.013.
    [16]
    血液净化急诊临床应用专家共识组.血液净化急诊临床应用专家共识[J].中华急诊医学杂志,2017,26(1):24-36.DOI: 10.3760/cma.j.issn.1671-0282.2017.01.007.0
    [17]
    LameireN,KellumJA,KDIGO AKI Guideline Work Group.Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2)[J].Crit Care,2013,17(1):205.DOI: 10.1186/cc11455.
    [18]
    ToveyL,DickieH,GangiS,et al.Beyond the randomized clinical trial: citrate for continuous renal replacement therapy in clinical practice[J].Nephron Clin Pract,2013,124(1/2):119-123.DOI: 10.1159/000355550.
    [19]
    SchilderL,NurmohamedSA,BoschFH,et al.Citrate anticoagulation versus systemic heparinisation in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: a multi-center randomized clinical trial[J].Crit Care,2014,18(4):472.DOI: 10.1186/s13054-014-0472-6.
    [20]
    QianW, WangS, WangY, et al. Epidemiological and clinical characteristics of burns in the older person: a seven-year retrospective analysis of 693 cases at a burn center in south-west China[J/OL].Burns Trauma, 2020, 8:tkz005[2020-12-01]. https://pubmed.ncbi.nlm.nih.gov/32346542/. DOI: 10.1093/burnst/tkz005.
    [21]
    GilleJ,SablotzkiA,MalcharekM,et al.Regional citrate anticoagulation for continuous renal replacement therapy in severe burns-a retrospective analysis of a protocol-guided approach[J].Burns,2014,40(8):1593-1601.DOI: 10.1016/j.burns.2014.01.028.
    [22]
    SchultheißC,SaugelB,PhillipV,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.DOI:1 0.1186/cc11485.
    [23]
    YouB,ZhangYL,LuoGX,et al.Early application of continuous high-volume haemofiltration can reduce sepsis and improve the prognosis of patients with severe burns[J].Crit Care,2018,22(1):173.DOI: 10.1186/s13054-018-2095-9.
    [24]
    HonorePM,Joannes-BoyauO,BoerW,et al.High-volume hemofiltration in sepsis and SIRS: current concepts and future prospects[J].Blood Purif,2009,28(1):1-11.DOI: 10.1159/000210031.
    [25]
    中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华内科杂志,2015,54(6):557-581.DOI: 10.3760/cma.j.issn.0578-1426.2015.06.021.
    [26]
    邱海波,杨毅.重症医学:规范·流程·实践[M]. 2版.北京:人民卫生出版社,2016:144.
    [27]
    叶禄伟,汪志刚,张民杰.连续性血液净化对重症脓毒症患者的血乳酸及血流动力学的影响[J].中国生化药物杂志,2017,37(5):416-418. DOI: 10.3969/j.issn.1005-1678.2017.05.141.
    [28]
    MorabitoS,PistolesiV,TritapepeL,et al.Regional citrate anticoagulation in cardiac surgery patients at high risk of bleeding: a continuous veno-venous hemofiltration protocol with a low concentration citrate solution[J].Crit Care,2012,16(3):R111.DOI: 10.1186/cc11403.
    [29]
    DrewryAM,SamraN,SkrupkyLP,et al.Persistent lymphopenia after diagnosis of sepsis predicts mortality[J].Shock,2014,42(5):383-391.DOI: 10.1097/SHK.0000000000000234.
    [30]
    ChungKK,LundyJB,MatsonJR,et al.Continuous venovenous hemofiltration in severely burned patients with acute kidney injury: a cohort study[J].Crit Care,2009,13(3):R62.DOI: 10.1186/cc7801.
    [31]
    RoncoC.Continuous renal replacement therapy: forty-year anniversary[J].Int J Artif Organs,2017,40(6):257-264.DOI: 10.5301/ijao.5000610.
    [32]
    胡高中,彭毅志,王凡,等.血液净化对烧伤脓毒症患者的作用[J].中华烧伤杂志,2014,30(3):213-218.DOI: 10.3760/cma.j.issn.1009-2587.2014.03.008.
    [33]
    丁羚涛,杨敏烈,朱宇刚,等.柠檬酸盐抗凝技术在危重烧伤脓毒症患者床旁连续性血液净化中的应用效果[J].中华烧伤杂志,2018,34(2):73-77.DOI: 10.3760/cma.j.issn.1009-2587.2018.02.003.
    [34]
    HuangLF,YaoYM,DongN,et al.Association between regulatory T cell activity and sepsis and outcome of severely burned patients: a prospective, observational study[J].Crit Care,2010,14(1):R3.DOI: 10.1186/cc8232.
    [35]
    李晓亮,肖宏涛,李延仓,等.柠檬酸对行连续性肾脏替代治疗的严重烧伤并发急性肾损伤患者的影响[J].中华烧伤杂志,2019,35(8):568-573.DOI: 10.3760/cma.j.issn.1009-2587.2019.08.003.
    [36]
    LiaoYJ, ZhangL, ZengXX, et al. Citrate versus unfractionated heparin for anticoagulation in continuous renal replacement therapy[J].Chin Med J (Engl), 2013, 126(7):1344-1349.DOI: 10.3760/cma.j.issn.0366-6999.20121179.
    [37]
    BaiM,ZhouM,HeL,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.DOI: 10.1007/s00134-015-4099-0.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(5)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (287) PDF downloads(40) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return