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目的:探讨局部柠檬酸抗凝在重症烧伤患者连续性静脉-静脉血液滤过中的效果。方法:采用回顾性非随机对照研究。2017年1月—2020年8月，南开大学附属医院收治符合入选标准的重症烧伤患者68例，均行连续性静脉-静脉血液滤过（CVVH）治疗。根据患者在CVVH治疗中采用的血液抗凝方式不同，分为柠檬酸组40例和肝素组28例。柠檬酸组患者中男32例、女8例，年龄（40±18）岁，烧伤总面积（62±14）%体表总面积（TBSA）；肝素组患者中男22例、女6例，年龄（38±16）岁，烧伤总面积（57±20）%TBSA。记录2组患者CVVH治疗0（即刻）、48、96 h时的血清肌酐水平、C反应蛋白（CRP）值、尿素氮水平并根据其水平计算尿素清除指数，记录血小板计数（PLT）及凝血全项中的凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）。记录CVVH治疗96 h内，患者出现严重低钙血症、创面出血加重、非创面的新发生出血等不良反应导致血液滤过受迫性终止的次数。记录患者每日血液净化滤器使用的时长。对数据行n χ2检验、重复测量方差分析、独立样本n t检验及Bonferroni校正。n 结果:2组患者治疗0 h血清尿素氮水平、肌酐水平及CRP值比较，差异均无统计学意义（n P>0.05）。柠檬酸组患者治疗48、96 h血清尿素氮水平、肌酐水平及CRP值均明显低于肝素组（n t=3.366、-2.315、2.942，-2.657、2.011、-2.441，n P<0.05），尿素清除指数均显著高于肝素组（n t=1.107、2.233，n P0.05）。柠檬酸组患者治疗48、96 h的PLT明显高于肝素组（n t=-3.417、-4.413，n P<0.05或n P<0.01）。柠檬酸组患者治疗48、96 h的PT均明显短于肝素组（n t=2.760、-3.655，n P<0.01），APTT均明显短于肝素组（n t=3.719、5.146，n P<0.05或n P<0.01）。治疗96 h内，柠檬酸组患者中出现1例低钙血症及1例创面出血加重，均导致血液滤过受迫性终止，未出现非创面新发生出血；肝素组患者中未出现低钙血症，但出现7例创面出血加重及2例非创面新发生出血（均在气管切开处），均导致血液滤过受迫性终止。柠檬酸组患者血液净化滤器使用时长为（11.7±4.8）h，明显长于肝素组的（6.6±2.5）h（n t=3.310，n P0.05). At 48 and 96 h after treatment, urea nitrogen level, creatinine level, and CRP value in serum of patients in citrate group were significantly lower than those in heparin group (n t=3.366, -2.315, 2.942, -2.657, 2.011, -2.441, n P<0.05), and urea clearance index of patients in citrate group was significantly higher than that in heparin group (n t=1.017, 2.233, n P0.05). At 48 and 96 h, PLT of patients in citrate group was significantly higher than that in heparin group (n t=-3.417, -4.143, n P<0.05 orn P<0.01), PT of patients in citrate group was significantly shorter than that in heparin group (n t=2.760, -3.655, n P<0.01), APTT of patients in citrate group was significantly shorter than that in heparin group (n t=3.719, 5.146, n P<0.05 orn P<0.01). Within 96 h of treatment, there was 1 case of hypocalcemia and 1 case of aggravated wound bleeding resulting in forced hemofiltration termination in citrate group, but there was no new bleeding on non-wound surface; in heparin group, there was no hypocalcemia, but 7 cases of aggravated wound bleeding and 2 cases of new bleeding on non-wound surface (both at the tracheotomy site) resulting in forced hemofiltration termination. The use time of blood purification filter of patients in citrate group was (11.7±4.8) h, obviously longer than (6.6±2.5) h in heparin group (n t=3.310, n P<0.01).n Conclusions:The use of regional citrate anticoagulation in CVVH treatment of severe burn patients has the advantages including little effect on coagulation function and high safety, can effectively prolong the use time of filter and improve the therapeutic effect, but this conclusion still needs to be further verified in clinical application.