CRRT. [DOI] /j.issn

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1 Med J Chin PLA, Vol. 41, No. 10, October 1, [ ] (CRRT) 19( ) ( n=5) CRRT ( n=7) CRRT ( n=7) (CI) %(1/7) 0(0/7) 40.0%(2/5) 38 (PLT) (P<0.05) HCO 3 (P<0.05) 38 (P<0.05) (APTT) (P<0.05) (P<0.05) 3 ph (PT) (INR) ALT CI (P>0.05) CRRT CRRT [ ] [ ] R835 [ ] A [ ] (2016) [DOI] /j.issn Effect of regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy rewarming in dogs with accidental hypothermia YUAN Rui 1, SHUAI Wei-zheng 2, LI Da-wei 2, LI Zhe 2, ZOU Jian-feng 2, LI Qi 2, HU Zi-long 2, WU Zhen-hua 2, ZHANG Zhi-cheng 2* 1 Navy Clinical College, Anhui Medical University, Hefei , China 2 Intensive Care Unit, Navy General Hospital of PLA, Beijing , China * Corresponding author, zhangzhichengicu@hotmail.com [Abstract] Objective To observe the influences of regional citrate or systemic heparin anticoagulation on acid-base balance, coagulation, electrolytes, serum creatinine, alanine aminotransferase (ALT) and cardiac index (CI) during continuous renal replacement therapy (CRRT) rewarming in accidental hypothermia dogs. Methods Nineteen adult beagles were given abdominal trauma coupled with deep hypothermia [(28 0.5) ] induced by seawater immersion for establishing animal model of trauma. According to rewarming ways, the animal models were randomly divided into three groups, comparison group (warm bath rewarming, n=5), CRRT rewarming-systemic heparin anticoagulation group (heparin anticoagulation group, n=7) and CRRT rewarming-regional citrate anticoagulation group (citrate anticoagulation group, n=7). During the rewarming routine blood examination was performed, and blood chemistry, coagulation function, blood gas and hemodynamic status were assayed, at the same time the mortality was recorded. Results During the rewarming, the mortality was 14.3% (1/7) in heparin anticoagulation group, 40.0% (2/5) in warm bath group and 0 in regional citrate anticoagulation group. Blood in creased to 38, the heparin anticoagulation group showed a significant decrease of platelet compared with citrate anticoagulation group and comparison group (P<0.05); The comparison group had a significant decrease of HCO 3 compared with the other two groups (P<0.05). When the body was increased to and 38, the comparison group showed significant increase of serum creatinine [ ] [ ] ( ) ICU( ) [ ] zhangzhichengicu@hotmail.com

2 compared with the other two groups (P<0.05); the heparin anticoagulation group presented significant prolongation of APTT compared with citrate anticoagulation group and comparison group (P<0.05). When the body increased to 30, and 38 respectively, the citrate anticoagulation group had significantly increased serum calcium compared with heparin anticoagulation group and comparison group (P<0.05). There was no difference in serum sodium, ALT and CI between the three groups at each time point (P>0.05). Conclusions CRRT plus warm bath rewarming have better effect on improving metabolic acidosis than warm bath rewarming alone in accidental hypothermia dogs. In comparison with systemic heparin anticoagulation, regional citrate anticoagulation has smaller influences on coagulation system and platelet when CRRT rewarming performed in accidental hypothermia dogs. [Key words] hypothermia; hemofiltration; anticoagulation 32~35 28~32 28 ( ) 12%~80% [1-2] [3] (CRRT) ph m m o l / L m m o l / L m m o l / L m m o l / L ~12kg ( n=5) (CRRT n=7) (CRRT n=7) h (30~35mg/kg) (1ml/ ) [ 10~15/(ml.kg) (PEEP)2cmH 2 O] PiCCO (CVP) 30min 3cm 6~8cm 3~4cm (0~100 ) (40 ) 2 ( 40 ) 5% [2~4ml/(kg.h)] 1. 5 Accura Bel l c o BLS812SD Hospitech Manu factor ing Ser v ices Sdn Bhd SH M-H BTL -U 3 (4000ml) 12ml 39 80ml/ m i n 20ml/h 500ml/h 500ml/h ( 4%) 2%~2.5% 5% 2~4ml/( k g.h) 5% 4~6ml/h 10~20U/(kg.h) APTT 30~60s 2~4ml/( k g.h) ph 7.35~ ~0.40mmol/L 1.00~1.20mmol/L 15~30mmol/L ( ) SPSS 20.0 x±s t

3 Med J Chin PLA, Vol. 41, No. 10, October 1, ( ) SNK-q P< %(1/7) 0(0/7) 40.0%(2/5) ph (P>0.05) 30 3 HCO 3 (P>0.05) 38 HCO 3 (P<0.05 1) (i n ter n at i o n a l normalized ratio INR) (PT) (P>0.05) 38 ( A P T T ) (P<0.05) 3 4 (P<0.05) 38 (P<0.05 2) (P>0.05) (P<0.05 3) (ALT) (P>0.05) 38 (P<0.05 4) 2.6 (CI) CI (P>0.05 5) ph of arterial blood 1 3 (x±s) Tab.1 Changes of aterial blood gas in three groups(x±s) Heparin anticoagulation group (n=7) Citrate anticoagulation group (n=7) Control group (n=5) HCO 3 Heparin anticoagulation group (n=7) (1) Citrate anticoagulation group (n=7) (1) Control group (n=5) (1)P<0.05 compared with control group INR (%) 2 3 (x±s) Tab.2 Changes of coagulation parameters in three groups (x±s) Heparin anticoagulation group (n=7) Citrate anticoagulation group (n=7) Control group (n=5) PT(s) Heparin anticoagulation group (n=7) Citrate anticoagulation group (n=7) Control group (n=5) APTT(s) Heparin anticoagulation group (n=7) (1)(2) (1)(2) Citrate anticoagulation group (n=7) Control group (n=5) Blood platelet ( 10 9 /L) Heparin anticoagulation group (n=7) (1) (1)(2) Citrate anticoagulation group (n=7) Control group (n=5) INR. International normalized ratio; PT. Prothrombin time; APTT. Activated partial thromboplastin time; (1)P<0.05 compared with control group; (2)P<0.05 compared with citrate anticoagulation group.

4 Serum sodium (mmol/l) 3 3 (x±s) Tab.3 Changes of serum electrolytes in three groups (x±s) Heparin anticoagulation group (n=7) Citrate anticoagulation group (n=7) Control group (n=5) Serum calcium (mmol/l) Heparin anticoagulation group (n=7) Citrate anticoagulation group (n=7) (1)(2) (1)(2) (1)(2) Control group (n=5) (1)P<0.05 compared with control group; (2)P<0.05 compared with heparin anticoagulation group ALT(U/L) 4 3 ALT (x±s) Tab.4 Changes of ALT and serum creatinine in three groups (x±s) Heparin anticoagulation group (n=7) Citrate anticoagulation group (n=7) Control group (n=5) Serum creatinine ( mol/l) Heparin anticoagulation group (n=7) (1) 38 4 (1) Citrate anticoagulation group (n=7) (1) 40 6 (1) Control group (n=5) (1)P<0.05 compared with control group 5 3 (L min 1 m 2 x±s) Tab.5 Changes of cardiac index in three groups (L min 1 m 2, x±s) Heparin anticoagulation group (n=7) Citrate anticoagulation group (n=7) Control group (n=5) [4] [5] [2,5-7] CRRT [8-10] CRRT CRRT CRRT CRRT CRRT [11] (AT- ) a a a a a [12] AT- AT- [13] [14] [15] CRRT

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