摘要目的:探讨不同滤器后离子钙（Ca 2+）浓度（0.25~0.35 mmol/L和>0.35~0.50 mmol/L）对应用局部枸橼酸抗凝（RCA）进行连续性肾脏替代治疗（CRRT）体外循环寿命的影响。 方法:回顾性分析四川大学华西医院 2021年3月至2022年6月应用RCA进行CRRT的患者资料，收集患者的基本信息及治疗开始后0、2、6 h及后续每6小时滤器后Ca 2+浓度值，按每次治疗Ca 2+浓度均值分为低浓度组（0.25~0.35 mmol/L）和高浓度组（>0.35~0.50 mmol/L），并通过1∶1进行倾向性评分匹配，评价不同滤器后Ca 2+浓度对体外循环寿命的影响。 结果:共纳入患者232例，男147例，女85例，年龄（58.2±16.9）岁。CRRT治疗431例次，共12 592 h，其中低浓度组317例次（73.5%），高浓度组114例次（26.5%）。将两组基线资料1∶1匹配后，每组纳入113例次进行分析。低浓度组和高浓度组凝血事件发生率分别为54.9%（62/113）和54.0%（61/113）（ P=0.894）；体外循环寿命［ M（ Q1， Q3）］分别为65.0（29.0，72.0）h和68.0（31.5，72.0）h（ P=0.805），差异均无统计学意义（均 P>0.05）；多因素Cox回归分析结果显示，滤器后Ca 2+浓度对体外循环寿命无明显影响（ HR=0.99，95% CI：0.55~1.79）。 结论:在应用RCA进行CRRT过程中，滤器后Ca 2+浓度目标值适当放宽至0.25~0.50 mmol/L，仍可能达到合格的抗凝。

abstractsObjective:To investigate the influence of different post-filter ionic calcium (Ca 2+) gradients (0.25-0.35 mmol/L vs>0.35-0.50 mmol/L) on the extracorporeal lifetime of local citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT). Methods:Patients who underwent CRRT with RCA at West China Hospital of Sichuan University from March 2021 to June 2022 were retrospectively selected. The basic information and the values of post-filter Ca 2+at 0, 2, and 6 hours after the start of treatment and every 6 hours thereafter were collected. The patients were divided into low concentration group (0.25-0.35 mmol/L mmol/L) and high concentration group (>0.35-0.50 mmol/L) according to the mean value of Ca 2+concentration per treatment, and propensity score matching was performed in a 1∶1 ratio to evaluate the effect of post-filter [iCa 2+] on the duration of extracorporeal circulation in different groups. Results:A total of 232 patients (147 males and 85 females) aged (58.2±16.9) years were enrolled. There were 431 cases treated with CRRT for 12 592 h, including 317 cases (73.5%) in the low concentration group and 114 cases (26.5%) in the high concentration group. The baseline data of the two groups were matched and analyzed. Coagulation events occurred in 54.9% (62/113) and 54.0% (61/113) in the low and high concentration groups, respectively ( P=0.894). The median survival on extracorporeal circulation was 65.0 (29.0, 72.0) h and 68.0 (31.5, 72.0) h in the two groups, respectively ( P=0.805). Multivariate Cox regression analyses showed that post-filter [iCa 2+] had no effect on extracorporeal life expectancy ( HR=0.99, 95% CI:0.55-1.79). Conclusion:During CRRT treatment with RCA, the desired anticoagulant effect can still be achieved when the post-filter [iCa 2+] target was set to 0.25-0.50 mmol/L.