以质量求发展，以服务铸品牌

Journal of Nursing ›› 2024, Vol. 31 ›› Issue (4): 48-53.doi: 10.16460/j.issn1008-9969.2024.04.048

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Best evidence summary for application and management of regional citrate anticoagulation in continuous renal replacement therapy

YANG Jian-guo1a, HE Xi-fei1b, YAN Jian-jun1a, ZHANG Meng1b, YANG Chun-zi1c, XU Rong1c, WANG Yan-fang2   

  1. 1a. Blood Purification Center; 1b. Teaching and Research Office of Internal Medicine, 1c. Dept. of Nursing Administration, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
    2. JBI Evidence-based Nursing Cooperation Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Received:2023-09-24 Online:2024-02-25 Published:2024-03-07

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Abstract: Objective To summarize the best evidence for the clinical application and management of regional citrate anticoagulation in continuous renal replacement therapy (RCA-CRRT). Methods Relevant guideline websites, databases and academic websites were systematically searched for the literature related to RCA-CRRT. Evidence extraction and integration from eligible literature was performed. Results Eighteen articles were included, including 3 evidence synthesis, 1 clinical decision, 2 clinical guidelines, 2 expert consensuses and 10 systematic reviews. Finally, 40 pieces of best evidence were formed from 6 aspects: scope of application, protocol development, parameter setting, process monitoring, catheter maintenance, and quality control. Conclusion To provide high-quality care for patients when conducting RCA-CRRT, personalized treatment plans and close monitoring of the treatment and coagulation can be developed by referring to the best evidence.

Key words: regional citrate anticoagulation, continuous renal replacement therapy, evidence summary, evidence-based nursing

CLC Number: 

  • R473.5
[1] Tandukar S, Palevsky PM.Continuous renal replacement therapy: who, when, why, and how[J]. Chest, 2019,155(3):626-638.DOI:10.1016/j.chest.2018.09.004.
[2] Kindgen-Milles D, Brandenburger T, Dimski T.Regional citrate anticoagulation for continuous renal replacement therapy[J]. Curr Opin Crit Care, 2018,24(6):450-454.DOI:10.1097/MCC.0000000000000547.
[3] Warnar C, Faber E, Katinakis PA, et al.Electrolyte monitoring during regional citrate anticoagulation in continuous renal replacement therapy[J]. J Clin Monit Comput, 2022,36(3):871-877.DOI:10.1007/s10877-021-00719-8.
[4] 张颖惠,张丽玉,王彩玲,等.局部枸橼酸抗凝连续性血液净化治疗离子钙监测优化方案的构建[J].护理研究,2022,36(11):1915-1919. DOI:10.12102/j.issn.1009-6493.2022.11.006
[5] 朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017,32(21):1991-1994.DOI:10.16821/j.cnki.hsjx.2017.21.025.
[6] Dicenso A, Bayley L, Haynes R B.Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs,2009,12(4):99-101.DOI:10.1136/ebn.12.4.99-b.
[7] 谢利民, 王文岳. 《临床指南研究与评价系统Ⅱ》简介[J]. 中西医结合学报,2012,10(2):160-165.DOI:10.3736/jcim20120206.
[8] 周芬, 郝玉芳, 丛雪, 等. 指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J]. 护理学报, 2018,25(18):56-58.DOI:10.16460/j.issn1008-9969.2018.18.056.
[9] 林晓露, 周春兰, 杨玲莉, 等. 尿毒症患者皮肤瘙痒管理的最佳证据总结[J]. 护理学报, 2022,29(17):38-42.DOI:10.16460/j.issn1008-9969.2022.17.038.
[10] Foster M J, Shurtz S.Making the Critical Appraisal for Summaries of Evidence(CASE) for evidence-based medicine (EBM): critical appraisal of summaries of evidence[J]. J Med Libr Assoc, 2013,101(3):192-198.DOI:10.3163/1536-5050.101.3.008.
[11] 杨玲莉, 周春兰, 赵慧慧, 等. 脑卒中患者呼吸肌训练的最佳证据总结[J]. 护理学报, 2022,29(15):49-53.DOI:10.16460/j.issn1008-9969.2022.15.049.
[12] 吴秀强, 杨珍, 谢志勤, 等. 护士道德困境干预的最佳证据总结[J]. 护理学报, 2023,30(1):47-52.DOI:10.16460/j.issn1008-9969.2023.01.047.
[13] 胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018.
[14] 顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具—分析性研究的质量评价[J]. 护士进修杂志, 2018,33(5):400-403.DOI:10.16821/j.cnki.hsjx.2018.05.005.
[15] 王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015,30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[16] 周英凤, 胡雁, 朱政, 等. JBI循证卫生保健模式的更新及发展[J]. 护理学杂志, 2017,32(3):81-83.DOI:10.3870/j.issn.1001-4152.2017.03.081.
[17] 杨建国, 何细飞, 鄢建军, 等. 无肝素连续性肾脏替代治疗体外循环凝血预防及管理的最佳证据总结[J]. 护理学报,2022,29(10):54-59.DOI:10.16460/j.issn1008-9969.2022.10.054.
[18] Mathew S. Evidence summary. Continuous renal replacement therapy:Regional citrate anticoagulation[EB/OL]. (2021-12-21)[2022-06-17].https://jbi.global/jbi-search?q=Regional+citrate+anticoagulation/JBI-ES-2003-1.
[19] Connor MJ, Karakala N.Continuous renal replacement therapy: Reviewing current best practice to provide high-quality extracorporeal therapy to critically ill patients[J]. Adv Chronic Kidney Dis,2017,24(4):213-218.DOI:10.1053/j.ackd.2017.05.003.
[20] Davenport A. Anticoagulation for continuous kidney replacement therapy[EB/OL].(2022-06-13)[2023-03-20]. https://www.uptodate.com/contents/anticoagulation-for-continuous-kidney-replacement-therapy.
[21] 国家肾脏病医疗质量控制中心. 血液净化标准操作规程(2021版)[EB/OL].(2021-11-08)[2022-01-12].http://www.cnrds.net/Static/QualityControlFile.html.
[22] 中国重症血液净化协作组, 中国重症血液净化协作组护理学组. 中国重症血液净化护理专家共识(2021年)[J]. 中华现代护理杂志, 2021,27(34):4621-4632.DOI:10.3760/cma.j.cn115682-20210428-01873.
[23] 中华医学会肾脏病学分会专家组. 连续性肾脏替代治疗的抗凝管理指南[J].中华肾脏病杂志, 2022,38(11):1016-1024.DOI:10.3760/cma.j.cn441217-20220620-00149.
[24] Alvarez G, Chrusch C, Hulme T, et al.Renal replacement therapy: a practical update[J]. Can J Anaesth, 2019,66(5):593-604.DOI:10.1007/s12630-019-01306-x.
[25] Tsujimoto H, Tsujimoto Y, Nakata Y, et al.Pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy[J]. Cochrane Database Syst Rev, 2020, 12(12):12467-12622.DOI:10.1002/14651858.CD012467.pub3.
[26] Li R, Gao X, Zhou T, et al.Regional citrate versus heparin anticoagulation for continuous renal replacement therapy in critically ill patients: a Meta-analysis of randomized controlled trials[J]. Ther Apher Dial, 2022,26(6):1086-1097.DOI:10.1111/1744-9987.13850.
[27] Chang H, Gong Y, Li C, et al.Clinical efficacy of regional citrate anticoagulation in continuous renal replacement therapy: systematic review and Meta-analysis[J]. Ann Palliat Med, 2021, 10(8):8939-8951.DOI:10.21037/apm-21-1693.
[28] Zhang W, Bai M, Yu Y, et al.Continuous renal replacement therapy without anticoagulation in critically ill patients at high risk of bleeding: a systematic review and Meta-analysis[J]. Semin Dial, 2021,34(3):196-208.DOI:10.1111/sdi.12946.
[29] Zhang W, Bai M, Yu Y, et al.Safety and efficacy of regional citrate anticoagulation for continuous renal replacement therapy in liver failure patients: a systematic review and Meta-analysis[J]. Crit Care, 2019,23(1):22-34.DOI:10.1186/s13054-019-2317-9.
[30] Peng B, Lu J, Guo H, et al.Regional citrate anticoagulation for replacement therapy in patients with liver failure:a systematic review and Meta-analysis[J]. Front Nutr, 2023,10:1031796.DOI:10.3389/fnut.2023.1031796.
[31] Brain M, Winson E, Roodenburg O, et al.Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and Meta-analysis[J]. BMC Nephrol, 2017,18(1):69-95.DOI:10.1186/s12882-017-0445-5.
[32] Rewa OG, Villeneuve P M, Lachance P, et al.Quality indicators of continuous renal replacement therapy (CRRT) care in critically ill patients: a systematic review[J]. Intensive Care Med, 2017,43(6):750-763.DOI:10.1007/s00134-016-4579-x.
[33] Liu C, Mao Z, Kang H, et al.Regional citrate versus heparin anticoagulation for continuous renal replacement therapy in critically ill patients: a Meta-analysis with trial sequential analysis of randomized controlled trials[J]. Crit Care, 2016, 20(1):144-158.DOI:10.1186/s13054-016-1299-0.
[34] 刘家红, 肖雯洁, 张静, 等. 局部枸橼酸抗凝的连续肾脏替代治疗过程中管路采血可行性的Meta分析[J]. 护理管理杂志, 2022,22(11):809-812.DOI:10.3969/j.issn.1671-315x.2022.11.008.
[35] Thanapongsatorn P, Chaijamorn W, Sirivongrangson P, et al.Citrate pharmacokinetics in critically ill liver failure patients receiving CRRT[J]. Sci Rep, 2022,12(1):1815-1823.DOI:10.1038/s41598-022-05867-8.
[36] 唐小琰, 张凌, 付平. 局部枸橼酸抗凝在间歇性血液透析中的应用进展[J]. 中国血液净化, 2021,20(6):387-390.DOI:10.3969/j.issn.1671-4091.2021.06.007.
[37] 唐前容, 马良, 张凌, 等. 局部枸橼酸抗凝行连续性肾脏替代治疗体外循环寿命的影响因素分析[J]. 华西医学, 2022,37(7):1001-1008.DOI:10.7507/1002-0179.202205162.
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