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Method for improving regional citric acid anticoagulation

A citric acid, topical technology, applied in the field of improved local citric acid anticoagulation, can solve the problems of endangering patients, hypercalcemia, and affecting the treatment effect

Inactive Publication Date: 2012-01-11
AFFILIATED HUSN HOSPITAL OF FUDAN UNIV
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

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Problems solved by technology

When the citric acid concentration in the body reaches a steady state, the ionized calcium originally chelated by citric acid is released and returned to the calcium pool. At this time, there is only the dialysis pathway for calcium removal through extracorporeal circulation. If calcium is still supplemented at the initial calcium supplementation rate , hypercalcemia is bound to occur, affecting the therapeutic effect and even endangering the patient

Method used

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  • Method for improving regional citric acid anticoagulation
  • Method for improving regional citric acid anticoagulation
  • Method for improving regional citric acid anticoagulation

Examples

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Embodiment 1

[0054] Example 1 CRRT partial citrate anticoagulant mathematical model establishment

[0055] 1) Calculate the total calcium concentration at the inlet of the CVVH dialyzer before dilution:

[0056] CcaT _ in = CcaT _ art × QP ( QP + Qcit + Qsub ) (Formula 1)

[0057] Among them: CcaT_in: total calcium concentration at the dialyzer inlet (mmol / L); CcaT_art: total calcium concentration before the dialyzer inlet after the arterial citrate infusion point (mmol / L); Qp: arterial before the citrate infusion point Terminal plasma flow; Qp=Qb×(1-Hct)×(1-protein concentration / 100), Hct: hematocrit (%), Qcit: citrate infusion rate (L / h); Qsub: replacement fluid speed(L / h)

[0058] Assuming the ratio of filterable calc...

Embodiment 2

[0080] Example 2 Model Verification

[0081] 1) Test subjects: 32 critically ill patients (median age 56.1 years old) admitted to Huashan Hospital ICU with acute renal failure requiring continuous blood purification treatment, including 28 males and 4 females. The average SOFA score before treatment was 11.9±3.4. The causes of acute renal failure included renal ischemia (n=11, 34.4%), renal tubular toxicity (n=5, 15.6%) and mixed (n=16, 50.00%). Most patients require citrate anticoagulation due to acute bleeding, thrombocytopenia, and coagulation dysfunction. None of the patients received blood transfusion or plasma exchange within 24 hours before the study. The research data of 17 patients were used to solve the coefficients of the mathematical model of calcium supplementation. The model was validated in 15 patients treated with CVVH. The research protocol was approved by the Ethics Committee of Huashan Hospital Affiliated to Fudan University (Ethics Review Protocol No. 2...

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Abstract

The invention belongs to the field of blood purification and relates to a method for improving the regional citric acid anticoagulation, in particular to the method for improving the regional citric acid anticoagulation based on a mathematical model. The method comprises two stages of quantificational calculation of calcium supplement amounts for citric acid anticoagulation, namely, in the first stage, quantificationally calculating the sum of in-vitro circulation clearing amount and in-vivo accumulation amount of calcium, and in the second stage, quantificationally calculating the in-vitro circulation clearing amount of the calcium only required to be supplemented. By the method, the infusion speeds of the citric acid and the calcium during regional citric acid anticoagulation during continuous renal replacement therapy (CRRT) can be quantificationally calculated, and the application range of the regional citric acid anticoagulation is greatly expanded. Corresponding application and verification are performed on critical patients requiring regional citric acid anticoagulation CRRT treatment. A result shows that the method is safe and effective and can stabilize in-vivo and in-vitro accumulation ionized calcium level in a proper range; the service life of a filter is prolonged; and the monitoring times are obviously reduced.

Description

technical field [0001] The invention belongs to the field of blood purification and relates to an improved local citric acid anticoagulant method. According to the mathematical model of citric acid and calcium dynamics in the process of continuous renal replacement therapy, the method proposes two-stage accurate and quantitative calculation of calcium supplementation Methods. This method can be used for quantitative regional citrate anticoagulation in continuous renal replacement therapy. Background technique [0002] Continuous renal replacement therapy (Continuous Renal replacement Therapy, CRRT) has many advantages over conventional hemodialysis, such as: better control of solution balance, stable hemodynamics, and slow and stable removal of solutes, which is beneficial to parenteral high blood pressure. Nutritional supplementation and removal of some inflammatory mediators have been more and more widely used in the treatment of critically ill patients with acute renal f...

Claims

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Application Information

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IPC IPC(8): A61M1/36A61K33/06
Inventor 丁峰郑寅许钟烨朱秋毓刘骏峰谢琼虹周莹赖凌云游怀舟郝传明顾勇林善锬
Owner AFFILIATED HUSN HOSPITAL OF FUDAN UNIV
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