Abstract：
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
摘要：
■研究局部枸橼酸抗凝（RCA）血浆置换（PE）的有效性和安全性，以及枸橼酸盐相关的代谢紊乱是否可以通过序贯RCA连续性肾脏替代治疗（CRRT）得到改善。
■这次回顾展，单中心观察性研究包括湖南省儿童医院儿科重症监护病房的79名需要PE的危重患儿（2018年6月至2021年6月），中国。将患者分为RCA-PE组（n=30）和全身性肝素抗凝（SHA-PE）组（n=49）。PE后过滤水平比较评估RCA-PE功效，PE和CRRT前后发生的代谢变化用于评估CRRT对RCA抗凝安全性的影响。
■RCA-PE组比SHA-PE组具有更好的整体过滤性能。PE后两小时，与SHA-PE组相比，RCA-PE组的pH和HCO-3水平增加更明显。代谢性碱中毒的RCA-PE发生率为48.3%,与SHA-PE组相比，高出4.2%(p<0.001)。在RCA-PE组中，CRRT后4h，pH和HCO--显着降低；RCA-PE引起的代谢性碱中毒降低至13.8％（p=0.005）。pH无显著差异,HCO-，CRRT后4h观察两组代谢性碱中毒发生率。
■RCA-PE的整体过滤性能优于SHA-PE，其次是CRRT。与RCA-PE相关的代谢并发症主要是代谢性碱中毒，可以通过在RCA-PE后使用CRRT来改善，这是危重病患儿PE期间抗凝的更好选择。
■这次回顾展，单中心观察性研究包括湖南省儿童医院儿科重症监护病房的79名需要PE的危重患儿（2018年6月至2021年6月），中国。将患者分为RCA-PE组（n=30）和全身性肝素抗凝（SHA-PE）组（n=49）。PE后过滤水平比较评估RCA-PE功效，PE和CRRT前后发生的代谢变化用于评估CRRT对RCA抗凝安全性的影响。
■RCA-PE组比SHA-PE组具有更好的整体过滤性能。PE后两小时，与SHA-PE组相比，RCA-PE组的pH和HCO-3水平增加更明显。代谢性碱中毒的RCA-PE发生率为48.3%,与SHA-PE组相比，高出4.2%(p<0.001)。在RCA-PE组中，CRRT后4h，pH和HCO--显着降低；RCA-PE引起的代谢性碱中毒降低至13.8％（p=0.005）。pH无显著差异,HCO
■RCA-PE的整体过滤性能优于SHA-PE，其次是CRRT。与RCA-PE相关的代谢并发症主要是代谢性碱中毒，可以通过在RCA-PE后使用CRRT来改善，这是危重病患儿PE期间抗凝的更好选择。
