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在接受全身抗凝肾脏替代治疗并发急性肾损伤危重患者中有超30%的患者可并发出血。由于出血与患者死亡风险增加有关,所以目前治疗策略在能维持体外循环的同时又能减少出血并发症的发生。在众多全身抗凝治疗的替代疗法中,局部枸橼酸抗凝表现为可以延长管路寿命同时减少出血并发症的发生率和降低输血需求的优点。综上所述,在最近出版的《改善全球肾脏病预后-急性肾损伤诊治指南》中推荐采用局部枸橼酸抗凝作为无禁忌症的重症患者进行CRRT的首选抗凝策略。
Bleeding can occur in up to 30% of patients critically ill with acute kidney injury who have undergone systemic anticoagulation and renal replacement therapy. Because bleeding is associated with an increased risk of death in patients, current treatment strategies can reduce the incidence of bleeding complications while maintaining cardiopulmonary bypass. In many surrogate treatments for systemic anticoagulant therapy, local citrate anticoagulation appears to provide the advantage of prolonging the life of the tubing while reducing the incidence of bleeding complications and reducing the need for blood transfusions. In summary, the recently published “Guidelines for the Improvement of Global Nephropathy Prostate-Acute Renal Injury Guidelines” recommends the use of topical citrate anticoagulation as the first choice of anticoagulation for CRRT in critically ill patients with no contraindications.