[Application of improved regional citrate anticoagulation in continuous hemofiltration in children]

Objective: To investigate the application of regional citrate anticoagulation with calcium hemofiltration basic solution in continuous hemofiltration in children. Method: The clinical data of 18 patients with citrate anticoagulation in continuous hemofiltration in children, excluding the hepatic failure and septic shock cases, were analyzed retrospectively, from September 2015 to August 2016 in Intensive Care Unit of the Children's Hospital of Chongqing Medical University.The commercial calcium hemofiltration basic solution was used as displacement liquid . The blood gas analysis, electrolyte, four coagulation tests during the treatment and the corresponding relations of quantity of blood flow(QB), quantity of citrate flow(QCi), quantity of sodium bicarbonate flow(QSB), quantity of calcium flow(QCa), quantity of filtered solution flow (Qf) were monitored. Meanwhile, the blood gas analysis, electrolyte, four coagulation tests, useful life of filter, bleeding and clotting events internal and external before, during and after the treatments were monitored, too. And the common complications of citrate anticoagulation, such as hypocalcaemia, metabolic alkalosis, citrate accumulation and hypernatremia were observed. Result: Continuous hemofiltration was applied in 18 patients for 734.5 hours, and the average useful life of filter was (25±11)h.There was no obvious clotting event. There were 168 groups of datum of the blood gas analysis, electrolyte, four coagulation tests during the treatment and the relationships of QB, QCi, QSB, QCa, Qf had been collected. The relationships of the initial parameter settings of QB, QCi, QSB, QCa and Qf were concluded as QCi=1.8×QB, QCa=0.12×QB, QSB=0.01×Qf . There were 150 times(89.3%)of extracorporeal ionized calcium(iCa(E)(2+)) and 162 times(96.4%) of intracorporal ionized calcium(iCa(I)(2+)) reached the anticoagulation target. Although all the comparisons of Na(+) ((136.2±4.1)vs.(138.2±2.4)vs.(138.5±3.9)mmol/L), iCa(2+) ((1.07±0.11)vs.(1.21±0.12)vs.(1.17±0.09)mmol/L), HCO(3)(-) ((22±4)vs.(28±5)vs. (26±4)mmol/L) among before, during and after treatment had significant difference(F=6.414, 18.950, 19.151; P=0.002, 0.000, 0.000). Each mean parameter was within the nearly normal range, except that the HCO(3)(-) increased slightly. High HCO(3)(-) was the most common complications, which happened 87 times (51.8%) during the treatment and 11 cases(37.9%) after the treatment. There was none with refractory hypocalcemia and total ionized calcium(TCa(2+) )/iCa(2+) above 2.5, which hints the accumulation of citrate. Conclusion: The commercialized displacement liquid containing calcium can be used in RCA-CHF in children safely and simply.