Application effect of regional citrate anticoagulation in continuous blood purification treatment at different stages after severe burns
10.3969/j.issn.1671-8348.2025.06.008
- VernacularTitle:枸橼酸局部抗凝在重症烧伤不同时期血液净化治疗中的应用效果
- Author:
Hualing CHEN
1
;
Ping WANG
;
Nian LIU
;
Liping YANG
;
Ning LI
;
Bo YOU
Author Information
1. 陆军军医大学第一附属医院全军烧伤研究所,创伤、烧伤与复合伤国家重点实验室,重庆 400038
- Keywords:
regional citrate anticoagulation;
blood purification;
burns;
coagulation function;
metabolic dysfunction
- From:
Chongqing Medicine
2025;54(6):1323-1328
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the efficacy and safety of regional citrate anticoagulation(RCA)in continuous blood purification(CBP)treatment during the shock and infection phases of severe burns.Methods A retrospective analysis was conducted on the clinical data of 64 patients who received RCA-CBP treatment at the Burns Reseaich Institute,the First Affiliated Hospital of Army Medical University from Jan-uary 2015 to January 2024.The patients were divided into the burn shock phase(burn duration<2 days,n=18)and the burn infection phase(burn duration≥2 days,n=46)according to the start time of CBP treat-ment.General datas,total body surface area burned(TBSA),abbreviated burn severity index(ABSI),hemato-crit(HCT)at the start of CBP treatment,platelet count(PLT),activated partial thromboplastin time(APTT),serum creatinine,urea nitrogen,total bilirubin,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,Child-Pugh score,filter usage time for each CBP treatment,the incidence of unplanned treatment termination,blood gas analysis,and adverse e-vents were compared between the two groups.Results Compared with the burn shock phase,the levels of HCT and PLT in the burn infection phase were lower,the levels of urea nitrogen and the incidences of shock,hyperlactatemia and hypoxemia were higher,the filter usage time was longer,and the incidence of unplanned treatment termination was lower,the differences were statistically significant(P<0.05).The results of mult-ivariate COX regression analysis showed that the burn shock phase was a protective factor for the filter usage time(P<0.05).Among the 64 patients,citrate accumulation occurred in 2 patients(3.1%),both of which were septic shock combined with hyperlactatemia during the burn infection stage.Patients with acid-base im-balance and electrolyte disorder were corrected after adjusting the treatment.There were 5 new bleeding e-vents,all of which were caused by the primary diseases.Conclusion RCA is safe and effective for CBP treat-ment in severe burned patients and can be used as a routine anticoagulant method.
