血液凈化治療過程中常面臨管路凝血、出血風(fēng)險等問題，正確選擇抗凝劑是持續(xù)有效進(jìn)行血液凈化的關(guān)鍵。枸櫞酸在體外循環(huán)管路中通過與鈣離子螯合起到體外抗凝作用，其在體內(nèi)迅速被氧化代謝而減少出血風(fēng)險的發(fā)生。結(jié)合枸櫞酸抗凝機(jī)制，回顧近年來國內(nèi)外枸櫞酸抗凝劑在高危出血患者持續(xù)性腎臟替代治療（CRRT）、血液透析、血漿置換、以及在肝功能損害等患者中的臨床應(yīng)用，并分析了其在抗凝治療過程中的限制點(diǎn)及風(fēng)險，為進(jìn)一步臨床推廣應(yīng)用提供參考。

When blood purification was performed in patients with high risk of coagulation and bleeding, it is often confronted with the risk of blood clotting and bleeding. It is essential to choose the adequate anticoagulant in order to perform successful blood purification. Citrate anticoagulant works by chelating with calcium ion in extracorporeal circulation loop, and quickly goes through oxidative metabolism process and hence reduces the risk of bleeding. In this article, the anticoagulant mechanism of regional citrate anticoagulation has been induced. This article also reviews the application of citrate anticoagulation in CRRT for patients with high risk of bleeding, and introduces the anticoagulant effects in hemodialysis, plasma exchange, and the application of RCA in patients with liver function lesion. The limits and risks of citrate anticoagulation in treatment were then analyzed. These analyses can provide references for popularizing citrate anticoagulants in clinical application.

廣西壯族自治區(qū)梧州市科學(xué)研究與技術(shù)開發(fā)計(jì)劃項(xiàng)目（201401038）