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） |
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| 摘要点击次数: 2025 |
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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. |
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