Comparison of the clinical effect between regional citrate anticoagulation and heparin anticoagulation in severe patients treated with blood filtration

Objective:To compare the clinical effects between regional citrate anticoagulation(RCA) and heparin anticoagulation in severe patients treated with continuous venous-venous hemofiltration(CVVH).Methods:The clinical data of 45 severe patients treated with CVVH were retrospectively analyzed.The patients were divided into the RCA-CVVH group(RCA group,25 cases) and heparin anticoagulation CVVH group(heparin group,20 cases) according to the anticoagulation method.The differences of the coagulant function,internal environment,renal function,bleeding complication and filter longevity before and after treatment between two groups were compared.Results:The differences of the activated partial thromboplastin time(APTT) and prothrombin time(PT) in RCA-CVVH group between before and after treatment were not statistically significant(P>0.05),and the levels of the Cr and BUN in RCA-CVVH group significantly decreased after treatment(P<0.01).Compared before treatment,the APTT and PT in heparin-CVVH group prolonged after treatment(P<0.01),and the levels of the Cr and BUN in heparin-CVVH group significantly decreased after treatment(P<0.01).Compared before treatment,the levels of Na⁺ and Ca2⁺ in RCA group decreased after treatment(P<0.01),the changes of the level of HCO3- and pH value in RCA group were not obvious after treatment(P>0.05).Compared before treatment,the changes of the levels of Na⁺,Ca2⁺ and HCO3^-,and pH value in heparin group were not obvious after treatment(P>0.05).The secondary hemorrhage in RCA group(1 cases,4%) was lower than that in heparin group(3 cases,15%)(P<0.05).The filter longevity in RCA group(35.26±7.60)h was longer than that in heparin group(20.75±5.3)h(P<0.01).Conclusions:The filtration effect of RCA-CVVH is similar to heparin,which is less effect on the coagulation function,does not increase the bleeding risk in severe patients,can prolong the filter longevity,and has better security and practicability.