Objective: To investigate the effects of application of
citrate anticoagulation in bedside continuous blood purification (CBP) of severe
burn patients with
sepsis, so as to provide reference for choosing
anticoagulants in CBP of these patients. Methods: Thirty severe
burn patients with
sepsis, conforming to the study criteria, were admitted to our
burn intensive care unit from January 2014 to July 2017. Patients were divided into
heparin group and
citrate group according to computer randomization method, with 15 cases in each group. Patients in two groups all received bedside CBP treatment. Patients in
heparin group used local
heparin anticoagulation, while patients in
citrate group used local
citrate anticoagulation. Time of predicted single-time CBP treatment, time of single-time CBP treatment, time of accumulative CBP treatment, and rate of reaching the standard of CBP treatment time were counted. Changes of prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR),
fibrinogen, serum
procalcitonin, and
C-reactive protein (CRP) of patients before and
after treatment were monitored.
Hemorrhage in
wounds, incision on trachea, and arteriovenous intubation point, and other complications during and after CBP treatment were observed. Data were processed with independent sample t test and chi-square test. Results: (1) Time of predicted single-time CBP treatment of patients in the two groups was equal. Time of single-time CBP treatment and time of accumulative CBP treatment of patients in
citrate group were longer than those in
heparin group. Rate of reaching the standard of CBP treatment time of patients in
citrate group was significantly higher than that in
heparin group (χ(2)=16.655, P<0.01). (2) There was no statistically significant difference in PT, APTT, INR,
fibrinogen, serum
procalcitonin, and CRP of patients in the two groups before CBP treatment (t=0.203, -1.006, 0.203, 0.039, -1.591, -0.824, P>0.05). PT and APTT of patients in
citrate group after CBP treatment were (14.2±1.6) and (45±7) s, respectively, significantly shorter than (15.5±1.4) and (53±6) s in
heparin group (t=2.395, 3.321, P<0.05 or P<0.01). INR of patients in
citrate group after CBP treatment was 1.13±0.12, significantly lower than 1.24±0.12 in
heparin group (t=2.395, P<0.05).
Fibrinogen of patients in
citrate group after CBP treatment was (3.5±0.6) g/L, significantly higher than (3.0±0.6) g/L in
heparin group (t=-2.427, P<0.05). Serum
procalcitonin and CRP of patients in
citrate group after CBP treatment were significantly lower than those in
heparin group (t=2.520, 2.710, P<0.05). Decreased degree of serum
procalcitonin and CRP of patients in
citrate group after CBP treatment were (1.8±0.6) ng/mL and (143±69) mg/L, respectively, significantly higher than (0.9±0.6) ng/mL and (95±50) mg/L in
heparin group (t=-4.033, -2.170, P<0.05 or P<0.01). (3) During CBP treatment, patients in
heparin group experienced 21 times of exacerbation of
wound hemorrhage and 10 times of new
hemorrhage, including 2 times of
hemorrhage at incision on trachea and 8 times of
hemorrhage at arteriovenous intubation point. No exacerbation of
hemorrhage or new
hemorrhage happened in patients of
citrate group. After CBP treatment, no
electrolyte disturbance happened in patients of
heparin group, but 1 patient in
citrate group experienced
hypocalcemia. Conclusions: Application of
citrate anticoagulation in bedside CBP of severe
burn patients with
sepsis shows light impact on systematic coagulation status, and can effectively decrease
inflammation reaction of
burn sepsis with low rate of
hemorrhage.