代谢性碱中毒
肾脏替代疗法
医学
重症监护室
病危
碱中毒
阿帕奇II
代谢性酸中毒
肝素
内科学
酸中毒
作者
Zhang Xinping,Jie He,Yao Zhenya,Dengya Zhu,Xiong Zhou
标识
DOI:10.1177/03913988231223375
摘要
Objective: To investigate the effectiveness and safety of regional citrate-anticoagulated (RCA) plasma exchange (PE) and whether citrate-related metabolic disorders can be improved by sequential RCA continuous renal replacement therapy (CRRT). Methods: This retrospective, single-center observational study included 79 critically ill children requiring PE followed by CRRT (June 2018 to June 2021) at the Pediatric Intensive Care Unit of Hunan Children’s Hospital, China. Patients were divided into the RCA-PE ( n = 30) and systemic heparin anticoagulation (SHA-PE) ( n = 49) groups. Filter level comparison post-PE assessed RCA-PE efficacy, and metabolic changes occurring pre- and post-PE and CRRT were used to evaluate the effect of CRRT on RCA-based anticoagulation safety. Results: The RCA-PE group had a better overall filter performance than the SHA-PE group. Two hours after PE, pH and HCO₃ − levels increased more significantly for the RCA-PE than the SHA-PE group. The RCA-PE incidence of metabolic alkalosis was 48.3%, higher by 4.2% ( p < 0.001) compared to the SHA-PE group. In the RCA-PE group, pH and HCO₃ − decreased significantly 4 h after CRRT; the metabolic alkalosis caused by RCA-PE decreased to 13.8% ( p = 0.005). No significant difference in pH, HCO₃ − , and metabolic alkalosis incidence was observed between the two groups 4 h after CRRT. Conclusions: The overall filtration performance of RCA-PE is superior to that of SHA-PE followed by CRRT. The metabolic complications associated with RCA-PE are mainly metabolic alkalosis that can be improved by using CRRT after RCA-PE and this is a better alternative for anticoagulation during PE in critically ill children.
科研通智能强力驱动
Strongly Powered by AbleSci AI