RCA-CRRT无创监测游离钙方式的探索

目的 探索在RCA-CRRT治疗时，利用管路动脉端直接采血来替代频繁外周静脉穿刺取样法。方法 借助新型双腔股静脉导管代替目前在用的导管（静脉内回血孔与静脉内血吸入孔的距离合理延长，防止局部再循环），用含枸橼酸前置换液，无钙、无碳酸氢盐、低钠。在置换液前动脉端、外周静脉同步采血，测两组的iCa浓度，比对两组iCa水平之间的差异，同时观测RCA的抗凝作用及其并发症。结果 配对t检验显示两组iCa值比较，差异无统计学意义（P=0.600），动脉端血液iCa浓度与外周静脉血高度一致。未出现枸橼酸盐中毒症状和代谢性碱中毒，无诱发出血或出血加重，无明显凝血，血钙浓度波动在理想范围内。结论 借助新型双腔股静脉导管，可利用动脉端iCa值替代外周静脉的数据，从而实现RCA-CRRT时iCa无创监测，节省医疗资源。

Exploration of Noninvasive Way of iCa Monitoring in the Treatment of RCA-CRRT

Objective To explore the possibility of direct blood collection from arterial line to replace the frequent peripheral venipuncture sampling in the treatment of RCA-CRRT. Methods With the help of a new type of dual-lumen femoral catheter in which the distance from the inner venous ports to the inner arterial ports was reasonably extended, extracorporeal circulation for RCA-CRRT was established with the pre-replacement solution contained citrate, zero Ca²⁺, zero bicarbonate. The iCa concentrations from the arterial line and peripheral vein of the two groups were measured synchronously,and the anticoagulant action of RCA and its complications were observed. Results Statistics stated that there was not significant difference (P=0.600) of iCa concentration between arterial line group and the peripheral vein group. There was a high degree of similarity between the iCa concentration of arterial line blood and the peripheral venous one. No citrate toxicity or metabolic alkalosis were found. None induced bleeding, or bleeding aggravated, no obvious clotting occurred. Systemic calcium concentration was achieved in the ideal range. Conclusion Blood sampling from arterial line can be used for iCa monitoring with the help of the new type of catheter in the treatment of RCA-CRRT instead of frequent peripheral venipuncture sampling.