■局部枸橼酸抗凝(RCA)在儿童中更常用于连续性肾脏替代治疗。很少有报道描述基于膜的治疗性血浆置换(mTPE)与RCA在肝功能衰竭(LF)儿童中的应用。
■探讨RCA-mTPE在LF儿童中的应用。
我们回顾性分析了在重庆医科大学附属儿童医院儿科重症监护病房接受RCA-mTPE的LF患儿的资料。我们使用总钙离子比(T/iCa)>2.5作为柠檬酸盐积累(CA)的诊断标准。根据RCA-mTPE结束时CA的发生情况分为两组(CA组:T/iCa>2.5;NCA组:T/iCa≤2.5)。为了评估RCA-mTPE的临床安全性和有效性,以下数据来自医疗记录进行了评估和组间比较:临床特征,LF的原因,RCA-mTPE参数和持续时间,实验室发现,和并发症。
■总共,92RCA-mTPE治疗对21名LF患儿进行3.8±0.9h。确定以下平均值:血液流速(QB)=2.8ml/kg/min,4%柠檬酸钠剂量/血流量比(QCi/QB)=1.1(QCi,ml/kg/h);血浆剂量/体重比(QP/BW)=18.5(QP,ml/kg/h);10%葡萄糖酸钙剂量/血流速度比(QCa/QB)=0.2(QCa,ml/kg/h)。iCa的体外平均浓度为0.38±0.07mmol/L。在34(37%)处理后记录柠檬酸盐积累。低钙血症发生在11例(12%)和7例(7.6%)治疗中,在MTPE期间和之后,分别。三个低血压和一个抽搐事件,与低钙血症有关,在RCA-mTPE期间发生了两次凝血事件。在RCA-mTPE之后,患者的pH值,HCO3-和Na+水平,和T/iCa显着增加,总胆红素(TB),结合胆红素(DB),凝血酶原时间(PT),活化部分凝血活酶时间(APTT),丙氨酸氨基转移酶(ALT),天冬氨酸转氨酶(AST),氨水平显著下降。TB,DB,和乳酸水平,在RCA-mTPE之前,CA组明显高于NCA组,但两组间QB/BW无显著性,QCi/QB,和QP/BW,mTPE持续时间,和估计代谢的柠檬酸盐的量。
■接受RCA-mTPE的LF患儿有低钙血症的风险。通过适当的协议调整,然而,RCA-mTPE可以安全有效地用于这些患者。
UNASSIGNED: Regional citrate anticoagulation (RCA) is being used more commonly in children for continuous renal replacement therapy. Few reports describe the application of membrane-based therapeutic plasma exchange (mTPE) with RCA in children with liver failure (LF).
UNASSIGNED: To explore the application of RCA-mTPE in children with LF.
UNASSIGNED: We retrospectively analyzed data from children with LF who underwent RCA-mTPE in the Children\'s Hospital of Chongqing Medical University\'s pediatric intensive care unit. We used the total to ionized calcium ratio (T/iCa) > 2.5 as the diagnostic criteria for citrate accumulation (CA). The patients were divided into two groups according to the occureence of CA at the end of RCA-mTPE (CA group: T/iCa > 2.5; NCA group: T/iCa ≤ 2.5). To evaluate the clinical safety and efficacy of RCA-mTPE, the following data from medical records were assessed and compared between groups: clinical characteristics, reasons for LF, RCA-mTPE parameters and duration, laboratory findings, and complications.
UNASSIGNED: In total, 92 RCA-mTPE treatments were administered to 21 children with LF over 3.8 ± 0.9 h. The following mean values were determined: blood flow rate (QB) = 2.8 ml/kg/min, 4% sodium citrate dose/blood flow rate ratio (QCi/QB) = 1.1(QCi,ml/kg/h); plasma dose/body weight ratio(QP/BW) = 18.5 (QP, ml/kg/h); 10% calcium gluconate dose/blood flow rate ratio (QCa/QB) = 0.2(QCa, ml/kg/h). The mean concentration of iCa in vitro was 0.38 ± 0.07 mmol/L. Citrate accumulation was recorded after 34 (37%) treatments. Hypocalcemia occurred in 11 (12%) and 7 (7.6%) treatments, during and after mTPE, respectively. Three hypotensive and one convulsive events, related to hypocalcemia, and two clotting events occurred during RCA-mTPE. After RCA-mTPE, the patients\' pH, HCO3- and Na+ levels, and T/iCa were significantly increased and the total bilirubin (TB), conjugated bilirubin (DB), prothrombin time (PT), activated partial thromboplastin time (APTT), alanine aminotransferase (ALT), aspartate aminotransferase (AST),and ammonia levels were significantly decreased. The TB, DB, and lactic acid levels, before RCA-mTPE, were significantly higher in the CA group than in the NCA group, but there were no significance between the two groups in QB/BW, QCi/QB, and QP/BW, mTPE duration, and estimated amount of citrate metabolized.
UNASSIGNED: Children with LF undergoing RCA-mTPE are at risk of hypocalcemia. With proper protocol adjustment, however, RCA-mTPE can be used safely and effectively in these patients.