Journal of Hebei Medical University ›› 2022, Vol. 43 ›› Issue (9): 1033-1036,1051.doi: 10.3969/j.issn.1007-3205.2022.09.009

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Effect of two-stage citrate anticoagulation combined with CVVH on inflammatory factors and serum HO-1 in patients with acute liver and kidney injury after cardiovascular surgery

  

  1. 1.Department of Blood Purification Center, the First People′s Hospital of Huaian City Affiliated to 
    Nanjing Medical University， Jiangsu Province, Huaian 223300， China；2.Department of Nephrology, 
    the First People′s Hospital of Huaian City Affiliated to Nanjing Medical University， Jiangsu Province, 
    Huaian 223300， China； 3.Department of Cardiology， the First People′s Hospital of Huaian City 
    Affiliated to Nanjing Medical University， Jiangsu Province, Huaian 223300， China

  • Online:2022-09-25 Published:2022-10-02

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Abstract: ObjectiveTo study the effect of two-stage citrate anticoagulation combined with continuous veno venous hemofiltration(CVVH) on inflammatory factors and serum HO-1 in patients with acute liver and kidney injury after cardiovascular surgery. 
MethodsA total of 112 patients with acute liver and kidney injury after cardiovascular surgery requiring CVVH were selected and divided into the control group(n=56) and the research group(n=56) according to the random table method. The control group was given heparin for anticoagulation, and the research group was given two-stage citrate anticoagulation(sodium citrate was given for anticoagulation in front of the filter and at the venous pot). Anticoagulant effectiveness,the service time of the filter, serum inflammatory factors and HO-1 between two groups were compared. In addition, adverse reactions were compared in the two groups. 
ResultsThere was no significant difference in anticoagulant effectiveness between two groups after treatment(P＞0.05). The service life of the filter in the research group was longer than that in the control group(P＜0.05). The prothrombin time(PT), activated partial thromboplastin time(APTT), and thrombin time(TT) of the two groups after treatment were longer than those before treatment, and longer in the research group than in the control group(P＜0.05). After treatment, C-reactive protein(CRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), and malondialdehyde(MDA) of the two groups were lower than those before treatment, which were lower in the research group than in the control group(P＜0.05). After treatment, the HO-1 levels of the two groups decreased compared with those before treatment, and the research group showed lower results(P＜0.05). The research group had lower incidence of complications than control group(P＜0.05). 
ConclusionTwo-stage citrate anticoagulation combined with CVVH in the treatment of patients with acute liver and kidney injury after cardiovascular surgery can reduce the level of inflammatory factors in the body, increase the service time of the filter, reduce the level of HO-1 in the body, and lower the risk of bleeding.


Key words: cardiovascular surgical procedures, two-stage citrate anticoagulation, hemofiltration