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Journal of Zhejiang University SCIENCE B
ISSN 1673-1581(Print), 1862-1783(Online), Monthly
2022 Vol.23 No.11 P.931-942
Application of regional citrate anticoagulation in patients at high risk of bleeding during intermittent hemodialysis: a prospective multicenter randomized controlled trial
Abstract: ObjectiveSafe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment.
MethodsPatients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline.
ResultsA total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P<0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group ((238.34±9.33) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (Kt/V) in the RCA group was similar to that in the saline flushing group with no statistically significant difference (1.12±0.34 vs. 1.08±0.34, P=0.41).
ConclusionsCompared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.
Key words: Regional citrate anticoagulation; Intermittent hemodialysis; Calcium-containing dialysate; Saline flushing; Anticoagulation
南京理工大学电子工程与光电技术学院，中国南京市，210094
摘要：功率放大器的线性度决定了通信系统的信号发射质量与系统的发射效率。非线性失真会导致系统误码、带外辐射以及临近信道干扰，严重影响着通信系统的质量和可靠性。论文从毫米波功率放大器的三阶互调点入手，对电路的非线性进行补偿。介绍了基于格罗方德（GlobalFoundries） 45 nm绝缘体硅工艺的AB类线性毫米波功率放大器（PA）的分析、设计和测试情况。设计了三种工作在U波段的基于共源共栅和三管堆叠单元结构的单端和差分堆叠功率放大器。根据非线性分析和在片测试结果对比，发现基于三管堆叠单元的设计要优于基于共源共栅单元的设计。使用单端测量方法设计的差分功率放大器在44 GHz时实现了47.2%的峰值功率附加效率（PAE）和25.2 dBm的饱和输出功率（Psat）。该放大器在44 GHz至50 GHz的工作带宽内实现了Psat高于23 dBm和峰值PAE高于25%的性能。
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DOI:
10.1631/jzus.B2200082
CLC number:
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On-line Access:
2024-08-27
Received:
2023-10-17
Revision Accepted:
2024-05-08
Crosschecked:
2022-11-16