• 局部枸橼酸钠抗凝连续性肾替代治疗中可通过管路采血监测钙浓度
  • Sampling blood through vessel with hemodialysis catheter for monitoring iCa2+ in patients with CRRT and regional citrate anticoagulation
  • 王海波.局部枸橼酸钠抗凝连续性肾替代治疗中可通过管路采血监测钙浓度[J].内科急危重症杂志,2021,27(4):
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    DOI:10.11768/nkjwzzzz20210415
    中文关键词:  重症患者  局部枸橼酸钠抗凝  连续性肾替代治疗  管路采血  iCa2+浓度
    英文关键词:
    基金项目:南通市卫计委科研基金项目(No:WKZD2018026)
    作者单位E-mail
    王海波 南通大学附属海安医院 zmzz8897@163.com 
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    中文摘要:
          目的:探讨对重症医学科(ICU)行局部枸橼酸钠抗凝(RCA)的连续性肾替代治疗(CRRT)患者通过管路采血检测钙离子(iCa2+)浓度的可行性。方法:回顾性分析2015年1月-2019年7月入住南通大学附属海安医院ICU患者100例,其中使用普通CRRT机器的患者50例,使用Ci-Ca专用仪器的患者50例。同时采集血滤管路内血液样本和动脉血,分别检测iCa2+浓度,并采用Bland-Altman法分析2种采血方式血液iCa2+浓度。观察患者一次性穿刺成功率和采血点不良反应发生率。结果:普通CRRT组和Ci-Ca专用CRRT组患者血滤管路采血和动脉采血,血液iCa2+浓度差异无统计学意义\[(1.058±0.083)mmol/L vs(1.069±0.085)mmol/L,(1.069±0.086)mmol/L vs(1.076±0.085)mmol/L,P均>0.05\]。绘制Bland-Altman散点图,2组患者血滤管路采血和动脉采血的血液iCa2+浓度具有一致性(P=0.0688,0.0599)。普通CRRT组血管内采血一次穿刺成功率为94.0%,穿刺位点渗血、淤青、血肿等不良反应发生率分别为10%、16%、8%,而血滤管路采血则未发生上述不良反应,且一次穿刺成功率均为100%。 结论:对于行RCA-CRRT治疗的ICU高危患者,通过血滤管路采血检测的iCa2+浓度与动脉血iCa2+浓度具有一致性,在密切监测iCa2+浓度的前提下可代替动脉穿刺采血。
    英文摘要:
          Objective: To observe the feasibility study on sampling blood through vessel with hemodialysis catheter for monitoring ionized calcium (iCa2+) during continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA). Methods: A total of 100 ICU patients who underwent RCA-CRRT in our hospital from January 2015 to July 2019 were retrospectively selected as the research subjects and divided into traditional CRRT group and Ci-Ca special CRRT group with 50 cases in each group. Sample arterial blood through hemodialysis catheter and arteries in traditional CRRT group, and sample blood through Ci-Ca catheter and arterial intubation in Ci-Ca special CRRT group was collected. iCa2+ concentrations were detected by blood gas analyzer. Bland-Altman plot method was used to detect the consistency of iCa2+ concentrations. Results The iCa2+ concentrations in hemodialysis catheter and arteries in traditional CRRT group were respectively (1.058±0.083) mmol/L and (1.069±0.085) mmol/L, and there was no statistical difference by paired-samples t test (P>0.05). The iCa2+ concentrations in Ci-Ca catheter and arterial intubation in Ci-Ca special CRRT group were respectively (1.069±0.086) mmol/L and (1.076±0.085) mmol/L, and there was no statistical difference by paired-samples t test (P>0.05). Bland-Altman plot method showed the difference in iCa2+ concentrations between hemodialysis catheter and arteries in traditional CRRT group or Ci-Ca catheter and arterial intubation in Ci-Ca special CRRT group without significant difference (P=0.0688, 0.0599). In traditional CRRT group, the successful rate of one-time puncture was 94.0%, and the incidence of bleeding, bruising and hematoma at the puncture site was 10%, 16% and 8% respectively, but the success rate of one puncture was 100% through catheters. Conclusions: During CRRT with regional 4% citrate anticoagulation, blood sampling through hemodialysis catheter or Ci-Ca catheter would replace the blood sampling through arteries under the condition of closely monitoring iCa2+ concentrations of precursors.