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Volume 37 Issue 12
Dec.  2021
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2021  >  37(12): 1137-1142
Wang ZY,Feng SH,Fan BL,et al.Effects of regional citrate anticoagulation in continuous veno-venous hemofiltration of severe burn patients[J].Chin J Burns,2021,37(12):1137-1142.DOI: 10.3760/cma.j.cn501120-20200816-00381.
Citation: Wang ZY,Feng SH,Fan BL,et al.Effects of regional citrate anticoagulation in continuous veno-venous hemofiltration of severe burn patients[J].Chin J Burns,2021,37(12):1137-1142.DOI: 10.3760/cma.j.cn501120-20200816-00381.
shu

Effects of regional citrate anticoagulation in continuous veno-venous hemofiltration of severe burn patients

doi: 10.3760/cma.j.cn501120-20200816-00381

  • Department of Burn Plastic Surgery, Affiliated Hospital of Nankai University (the Fourth Hospital of Tianjin) , Tianjin 300222, China

Funds:

Natural Science Foundation of Tianjin 19JCYBJC27700

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  • Corresponding author: Feng Shihai, Email: fengshihai888@hotmail.com
  • Received Date: 2020-08-16
    Abstract
  •   Objective  To investigate the effects of regional citrate anticoagulation in continuous veno-venous hemofiltration (CVVH) of severe burn patients.  Methods  A retrospective non-randomized controlled study was conducted. From January 2017 to August 2020, sixty-eight severe burn patients who met the inclusion criteria were treated with CVVH in Affiliated Hospital of Nankai University. According to the different methods of blood anticoagulation in CVVH treatment, patients were divided into citrate group (n=40) and heparin group (n=28). In the citrate group, 32 males and 8 females were (40±18) years old with total burn area of (62±14)% total body surface area (TBSA); in the heparin group, 22 males and 6 females were (38±16) years old with total burn area of (57±20)%TBSA. Creatinine level, C-reactive protein (CRP) value, and urea nitrogen level in serum of patients were recorded at 0 (immediately), 48, and 96 h after CVVH treatment in 2 groups, urea clearance index was calculated based on urea nitrogen level at 0, 48, and 96 h after CVVH treatment in 2 groups, platelet count (PLT), prothrombin time (PT), and activated partial thromboplastin time (APTT) in total coagulation of patients were recorded. The frequency of forced hemofiltration termination caused by adverse reactions such as severe hypocalcemia, aggravated wound bleeding, and new bleeding on non-wound surface of patients was recorded within 96 h of CVVH treatment. The duration of daily CVVH use from the beginning to the end was recorded. Data were statistically analyzed with chi-square test, analysis of variance for repeated measurement, independent samples t test, and Bonferroni correction.  Results  There were no significant differences in urea nitrogen level, creatinine level, and CRP value in serum of patients between 2 groups at 0 h after treatment (P>0.05). At 48 and 96 h after treatment, urea nitrogen level, creatinine level, and CRP value in serum of patients in citrate group were significantly lower than those in heparin group (t=3.366, -2.315, 2.942, -2.657, 2.011, -2.441, P<0.05), and urea clearance index of patients in citrate group was significantly higher than that in heparin group (t=1.017, 2.233, P<0.05). There were no statistically significant differences in PLT, PT, and APTT of patients between 2 groups at 0 h after treatment (P>0.05). At 48 and 96 h, PLT of patients in citrate group was significantly higher than that in heparin group (t=-3.417, -4.143, P<0.05 or P<0.01), PT of patients in citrate group was significantly shorter than that in heparin group (t=2.760, -3.655, P<0.01), APTT of patients in citrate group was significantly shorter than that in heparin group (t=3.719, 5.146, P<0.05 or P<0.01). Within 96 h of treatment, there was 1 case of hypocalcemia and 1 case of aggravated wound bleeding resulting in forced hemofiltration termination in citrate group, but there was no new bleeding on non-wound surface; in heparin group, there was no hypocalcemia, but 7 cases of aggravated wound bleeding and 2 cases of new bleeding on non-wound surface (both at the tracheotomy site) resulting in forced hemofiltration termination. The use time of blood purification filter of patients in citrate group was (11.7±4.8) h, obviously longer than (6.6±2.5) h in heparin group (t=3.310, P<0.01).  Conclusions  The use of regional citrate anticoagulation in CVVH treatment of severe burn patients has the advantages including little effect on coagulation function and high safety, can effectively prolong the use time of filter and improve the therapeutic effect, but this conclusion still needs to be further verified in clinical application.

     

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    • References(33)
  • [1]
    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.
    [2]
    ClarkWR, NeriM, GarzottoF, et al. The future of critical care: renal support in 2027[J]. Crit Care, 2017,21(1):92. DOI: 10.1186/s13054-017-1665-6.
    [3]
    MacraeJM, DojcinovicI, DjurdjevO, et al. Citrate 4% versus heparin and the reduction of thrombosis study (CHARTS)[J]. Clin J Am Soc Nephrol, 2008,3(2):369-374. DOI: 10.2215/CJN.01760407.
    [4]
    张莉, 孙雪峰, 张冬, 等. 不同抗凝剂对血液透析过程凝血状态的影响[J].中华肾脏病杂志, 2009,25(5):335-340.DOI: 10.3760/cma.j.issn.1001-7097.2009.05.003.
    [5]
    喻文, 罗红敏. 局部枸橼酸抗凝在连续性血液净化治疗MODS中的安全性和有效性[J].中华危重病急救医学,2018,30(8):753. DOI: 10.3760/cma.j.issn.2095-4352.2018.08.102.
    [6]
    YoonJ, KymD, HurJ, et al. Comparative usefulness of sepsis-3, burn sepsis, and conventional sepsis criteria in patients with major burns[J]. Crit Care Med, 2018,46(7):e656-e662. DOI: 10.1097/CCM.0000000000003144.
    [7]
    王奎,杨定平. 局部枸橼酸抗凝在高危出血风险血液透析患者中的应用[J]. 临床肾病杂志,2018,18(1):17.DOI: 10.3969/j.issn.1671-2390.2018.01.004.
    [8]
    庄冰,杨俊伟. 局部枸橼酸抗凝在连续性肾脏替代治疗中的应用[J]. 中华医学杂志,2017,97(36):2875-2877.DOI: 10.3760/cma.j.issn.0376-2491.2017.36.023.
    [9]
    GattasDJ,RajbhandariD,BradfordC,et al.A randomized controlled trial of regional citrate versus regional heparin anticoagulation for continuous renal replacement therapy in critically ill adults[J].Crit Care Med,2015,43(8):1622-1629. DOI: 10.1097/CCM.0000000000001004.
    [10]
    StuckerF, PonteB, TatawJ, et al. Efficacy and safety of citrate-based anticoagulation compared to heparin in patients with acute kidney injury requiring continuous renal replacement therapy: a randomized controlled trial[J]. Crit Care, 2015,19(1):91. DOI: 10.1186/s13054-015-0822-z.
    [11]
    LiuC, MaoZ, KangH, et al. Regional citrate versus heparin anticoagulation for continuous renal replacement therapy in critically ill patients: a meta-analysis with trial sequential analysis of randomized controlled trials[J]. Crit Care, 2016,20(1):144. DOI: 10.1186/s13054-016-1299-0.
    [12]
    LinT, SongL, HuangR, et al. Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies[J]. BMC Nephrol, 2019,20(1):472. DOI: 10.1186/s12882-019-1661-y.
    [13]
    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.
    [14]
    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.
    [15]
    郭峰,梁勋,郇京宁.持续血小板减少症预测严重烧伤并发脓毒症的临床意义[J].中华烧伤杂志,2014,3(4):295-298. DOI: 10.3760/cma.j.issn.1009-2587.2014.04.002.
    [16]
    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.
    [17]
    MeerschM, KullmarM, MempeC,et al. Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill patients with acute kidney injury (RICH) trial: study protocol for a multicentre, randomised controlled trial[J]. BMJ Open,2019,9(1):e024411.DOI: 10.1136/bmjopen-2018-024411.
    [18]
    乐伟波, 龚德华. 枸橼酸的代谢动力学及其在连续性血液净化中的应用[J].肾脏病与透析肾移植杂志,2009,18(4):363-366. DOI: 10.3969/j.issn.1006-298X.2009.04.014.
    [19]
    武云珍,张玉霞,王鹏,等. CVVH模式下置换液及枸橼酸输注的数学计算模型设计与分析[J]. 中华危重病急救医学,2019,31(6):725-730.DOI: 10.3760/cma.j,issn.2095-4352.2019.06.013.
    [20]
    JacobsR,HonorePM,BagshawSM, et al. Citrate formulation determines filter lifespan during continuous veno-venous hemofiltration: a prospective cohort study[J]. Blood Purif, 2015,40(3):194-202.DOI: 10.1159/000438820.
    [21]
    StraatenHM. Citrate for continuous renal replacement therapy: safer, better and cheaper[J]. Critical Care,2014,18(6):1.DOI: 10.1186/s13054-014-0661-3.
    [22]
    杨德淑,杨平,张艳,等. 不同抗凝方案在严重脓毒血症血小板减少患者CRRT中的应用[J]. 重庆医学,2014,43(28):3724.DOI: 10.3969/j.issn.1671-8348.2014.28.009.
    [23]
    Claure-Del GranadoR, MacedoE, SorokoS, et al. Anticoagulation, delivered dose and outcomes in CRRT: the program to improve care in acute renal disease (PICARD)[J]. Hemodial Int, 2014,18(3):641-649. DOI: 10.1111/hdi.12157.
    [24]
    HeungM,YessayanL.Renal replacement therapy in acute kidney injury: controversies and consensus[J].Crit Care Clin,2017,33(2):365-378. DOI: 10.1016/j.ccc.2016.12.003.
    [25]
    SchwarzerP, KuhnSO, StrackeS, et al. Discrepant post filter ionized calcium concentrations by common blood gas analyzers in CRRT using regional citrate anticoagulation[J]. Crit Care,2015,19(1):321.DOI: 10.1186/s13054-015-1027-1.
    [26]
    MedowJE, SanghviSR, HofmannRM. Use of high-flow continuous renal replacement therapy with citrate anticoagulation to control intracranial pressure by maintaining hypernatremia in a patient with acute brain injury and renal failure[J]. Clin Med Res,2015,13(2):89-93.DOI: 10.3121/cmr.2014.1238.
    [27]
    LahmerT, MesserM, RaschS, et al. Sustained low-efficiency dialysis with regional citrate anticoagulation in medical intensive care unit patients with liver failure: a prospective study[J]. J Crit Care, 2015,30(5):1096-1100. DOI: 10.1016/j.jcrc.2015.06.006.
    [28]
    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.
    [29]
    宁琪琪, 孟庆华, 朱跃科. 局部枸橼酸抗凝在肝衰竭患者进行持续肾脏替代治疗中的应用进展[J].中华肝脏病杂志,2018,26(7):549-552.DOI: 10.3760/cma.j.issn.1007-3418.2018.07.015.
    [30]
    张春, 林婷, 张靖垚, 等. 局部枸橼酸抗凝在肝切除术后急性肾损伤连续性肾脏替代治疗中临床疗效评价[J].中华危重病急救医学,2018,30(8):777-782. DOI: 10.3760/cma.j.issn.2095-4352.2018.08.013.
    [31]
    De VicoP,MessinoV,TartaglioneA,et al. Safety and efficacy of citrate anticoagulation continuous renal replacement therapies in post-cardiac surgery patients with liver dysfunction[J]. Therapeutic Apheresis and Dialysis,2015,19(3):272-278.DOI: 10.1111/1744-9987.12280.
    [32]
    FallP, SzerlipHM. Continuous renal replacement therapy: cause and treatment of electrolyte complications[J]. Semin Dial, 2010,23(6):581-585. DOI: 10.1111/j.1525-139X.2010.00790.x.
    [33]
    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.
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