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目的:了解国内急诊科行连续性肾脏替代治疗（CRRT）时应用局部枸橼酸抗凝（RCA）的现状。方法:2019年8月1日至4日，在一次全国急诊会议上，采用方便抽样法对不同地区不同级别医院的参会人员进行网络问卷调查，收集关于急诊CRRT时RCA的开展现状及限制因素方面的数据。结果:本次调查通过网络收集问卷407份，答题完整性高达100%；剔除23份存在逻辑错误的答卷，最终共384份问卷纳入分析，问卷有效率为94.35%。共有来自29个省、自治区、直辖市的参会代表参与问卷调查，所在医院以三级甲等为主〔70.31%（270/384）〕。调查结果显示，61.46%（236/384）的急诊科可独立开展CRRT；多数急诊科每月行CRRT少于10例〔52.87%（166/314）〕。在开展CRRT的急诊科中，肝素是被广泛应用且能熟练掌握的抗凝药物〔82.17%（258/314）〕，可熟练应用RCA的急诊科有199家（63.38%）；多数急诊科在无禁忌情况下行CRRT时首选肝素抗凝〔49.68%（156/314）〕，其次为局部枸橼酸盐〔25.80%（81/314）〕和低分子肝素〔23.56%（74/314）〕。在可熟练应用RCA的急诊科中，局部枸橼酸抗凝剂以4%枸橼酸钠为主〔68.34%（136/199）〕；RCA抗凝方式多数借鉴肾内科或透析中心方式（29.65%）；多数急诊科均可在4 h内调节滤器前血中游离Can 2+达到0.9～1.2 mmol/L目标安全水平〔88.94%（177/199）〕，调节滤器后血中游离Can 2+达到0.2～0.4 mmol/L目标理想抗凝水平〔93.47%（186/199）〕；枸橼酸蓄积〔58.29%（116/199）〕、代谢性碱中毒〔54.77%（109/199）〕和代谢性酸中毒〔37.19%（74/199）〕 是急诊科医生普遍担心发生的并发症。在281家不能应用RCA的急诊科中，费用较肝素高（31.67%）、不会使用或不熟练（21.00%）、枸橼酸来源受限（17.08%）、担心发生并发症（11.74%）等因素限制了RCA的使用。急诊CRRT时常用的置换液以市售成品含钙置换液为主（45.54%）；多数情况下急诊CRRT滤器寿命在12～23 h（39.49%）。n 结论:国内急诊CRRT治疗时应用RCA情况仍不理想，对RCA的认识有待提高，需要制定适合我国急诊科CRRT治疗的RCA方案，并加强CRRT治疗培训。“,”Objective:To investigate the status of regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) in emergency department.Methods:Participants of a national emergency conference from August 1st to August 4th in 2019 from hospitals of different levels in different regions were interviewed by online questionnaire to collect data about the current status and limitations of the application of RCA in emergency CRRT by convenient sampling.Results:Totally 407 questionnaires were collected through internet, and the completeness of the answers was as high as 100%. Twenty-three responses with logic errors were excluded, and 384 questionnaires were finally retrieved, with an effective rate of 94.35%. Representatives from 29 provinces, autonomous regions and municipalities directly under the Central Government participated in the questionnaire survey, and the hospitals in which they worked were mainly class Ⅲ grade A [70.31% (270/384)]. The survey showed that 61.46% (236/384) of the emergency departments could carry out CRRT independently. There were less than 10 CRRT cases per month in most emergency departments [52.87% (166/314)]. In the emergency departments where CRRT were carried out, heparin was a widely used and well-applied anticoagulant [82.17% (258/314)], and 199 emergency departments (63.38%) were proficient in RCA. In clinical practice, heparin [49.68% (156/314)] was preferred to RCA [25.80% (81/314)] and low molecular weight heparin [23.56% (74/384)]. In the emergency departments where RCA could be used skillfully, 4% sodium citrate was the main regional anticoagulant [68.34% (136/199)]. Anticoagulation protocol came from different sources, most of which were from nephrology or dialysis center (29.65%). Most departments could adjust the ionized calcium before the filter to the target safety level [0.9-1.2 mmol/L, 88.94% (177/199)], and adjust the ionized calcium after the filter to the target ideal anticoagulation level [0.2-0.4 mmol/L, 93.47% (186/199)] within 4 hours. The common complications that emergency physicians concerned were accumulation of citrate [58.29% (116/199)], metabolic alkalosis [54.77% (109/199)] and metabolic acidosis [37.19% (74/199)]. In 281 emergency departments that could not use RCA, there were kinds of factors that limited the use of citrate, such as higher cost than heparin (31.67%), unskilled personnel (21.00%), limited source of citrate (17.08%), concerns of complications (11.74%). At present, the substitution fluids used in clinical practice were mainly the commercial products (45.54%). In most cases, emergency CRRT filters had a life span of 12-23 hours (39.49%).Conclusions:The use of RCA in domestic emergency CRRT is low. Compared with the international peers, we are still lacking of adequate understanding of RCA. Therefore, it is necessary to develop an anticoagulation protocol of RCA for emergency departments in China, and promote training of CRRT.