Clinical research on regional citrate anticoagulation for continuous veno-venous hemofiltration in children

Abstract

Objective To study the reasonable doses, efficacy and safety of regional citrate anticoagulation(RCA) for continuous veno-venous hemofiltration(CVVH) in children. Methods There were 66 patients hospita-lized in Pediatric Intensive Care Unit of Zhujiang Hospital, Southern Medical University treated with RCA-CVVH that were recruited in the study from October 2012 to July 2014.The patients were divided into 4 groups according to their weight: ≤10 kg(group Ⅰ), 20 kg≥weight>10 kg(group Ⅱ), 30 kg≥weight>20 kg(group Ⅲ), >30 kg(group Ⅳ), and each group randomly received 2 different doses of anticoagulant acid citrate dextrose formula A(ACD-A): ACD-A(mL/h)=0.75×blood flow rate(BFR)(mL/min)(A dose) and ACD-A=1.5×BFR(B dose). Data of hemofilter duration, activated partial thromboplastin time(APTT)(systemic and circuit), ionized calcium(Ca2+) (systemic and circuit), blood urea nitrogen(BUN), serum creatinine(Cr), alanine aminotransferase(ALT), aspartate aminotransferase(AST), blood pH, sodium ion(Na+), bicarbonate ion(HCO3-) were collected and analyzed. Results There was no significant difference in BUN, Cr, ALT, AST and APTT of 2 different doses of ACD-A among the groups(all P>0.05); pH of B dose of ACD-A in group Ⅰwas significantly higher than that in A dose(F=7.384, P=0.015); pH of B dose of ACD-A in group Ⅱ was significantly higher than that in A dose(F=4.492, P=0.046), HCO3- of B dose of ACD-A in group Ⅰ was significantly higher than that in A dose(F=7.735, P=0.013); HCO3- of B dose of ACD-A in group Ⅱwas significantly higher than that in A dose(F=4.644, P=0.042); hemofilter duration of B dose of ACD-A in group Ⅲ was significantly higher than that in A dose(t=-3.147, P=0.016); hemofilter duration of B dose of ACD-A in group Ⅳ was significantly higher than that in A dose(t=-6.342, P=0.000). Conclusions RCA-CVVH is effective and safe for critical children, and different doses of ACD-A for children with different weight can reduce metabolic alkalosis and enhance regional anticoagulation. Key words: Continuous veno-venous hemofiltration; Child; Citrate; Anticoagulation