Clinical evaluation of continuous renal replacement therapy without anticoagulation for critically ill children with high risk of bleeding
10.3760/cma.j.issn.1673-4912.2016.05.009
- VernacularTitle:无抗凝连续性肾脏替代治疗在高危出血风险危重症儿童中的临床应用
- Author:
Liuhong SHI
;
Ying WANG
;
Jian ZHANG
;
Biru LI
;
Xiaowei HU
;
Juan QIAN
;
Hong REN
- Publication Type:Journal Article
- Keywords:
Continuous renal replacement therapy;
Without anticoagulation;
Heparin;
Bleeding
- From:
Chinese Pediatric Emergency Medicine
2016;23(5):325-328,332
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the safety and therapeutic efficiency of continuous renal replacement therapy(CRRT) without anticoagulation for critically ill children with high risk of bleeding.Methods We retrospectively analyzed 51 patients undergoing bedside CRRT in the PICU of our hospital from December 2007 to July 2015.Patients were divided into two groups induding CRRT with anticoagulation(n=33) or without anticoagulation (n=18).The therapeutic efficiency and complications were compared between two grous.Results Totally 168 CRRT circuits were performed in these 51 patients including 62 (36.9％)circuits without anticoagulation in 18 patients with high risk of bleeding and 106(63.1％) with anticoagulation by heparin.The circuits life of CRRT without anticoagulation was (12.31±6.64) h,which was shorter than that of CRRT with anticoagulation [(17.43±9.97)h] (P＜0.001).The levels of blood creatinine,blood urea nitrogen,C-reactive protein,and lactate significantly improved after both therapies (P＜0.05).PT and APTT did not change in CRRT without anticoagulation for hemorrhagic complications(P＞0.05).APTT[(52.36±5.00)s vs.(76.48±9.02)s,P=0.013] and PLT[(127.3±20.85)×109/L vs.(95.52±15.46)×109/L,P=0.041]were significantly longer in CRRT with anticoagulation by heparin compared with those before treatment.Conclusion CRRT without anticoagulation reduces bleeding risks and achieves an acceptable circuit life.The strategy can be applied as an alternative to critically ill children at high risks of bleeding who need continuous blood purification.
