新型枸橼酸盐浓缩抗凝血液透析液的实验研究  

The hemodialysis with the new type concentration anticoagulating hemodialysate in dogs

作　　者：桂保松[1] 吕星[1] 高卫华[1] 王亮琪[1] 郭蕊军[1] 姚钢炼[1] 

机构地区：[1]西安交通大学第二医院血液净化中心,西安710004

出　　处：《中国血液净化》2002年第3期36-41,共6页Chinese Journal of Blood Purification

基　　金：陕西省科技攻关基金资助项目(NO:2001K10-GZ-4)

摘　　要：目的 采用枸橼酸钠作为碱基研制成浓缩抗凝血液透析液,为解决高危出血病人血液透析中的抗凝难题探索一种新方法。方法 对10只犬不同时段行无肝素碳酸氢盐血液透析、枸橼酸盐透析液血液透析和肝素碳酸氢盐血液透析,测定透析过程中动静脉端的活化凝血时间(ACT)、BUN和血Cr以及透析前后的ALT、AST、TBIL、DBIL、Ca^(2+)、Cl^-、HCO_3^-。结果 枸橼酸盐透析液血液透析过程中,透析器后的ACT较透析器前的ACT明显延长(P<0.01);透析器后的血钙较透析器前的血钙有显著下降(P<0.01);透析器后的BUN、血Cr较透析器前有显著下降(P<0.01);与肝素抗凝的碳酸氢盐血液透析相比,其透析器的全血清除率略有提高,但无统计学差异(P>0.05);透析2小时后BUN、血Cr、TBIL、DBIL明显下降,与透析前相比有显著差异(P<0.01)。而 ALT、AST、Ca^(2+)、K^+、Na^+、Cl^-、HCO3^-均无明显改变(P>0.05)。结论 应用新型枸橼酸盐透析液有明显的局部抗凝效果,基本上可维持血液净化体外循环时间,其抗凝作用明显优于无肝素血液透析;无代谢性碱中毒,无高钠血症。Objective To observe the hemodialysis effect of the new type eoncentration anticoagulating hemodialysate. Methods 10 dogs received intermittent hemodialysis and were divided into 3 groups according to hemodialysis manner. Group 1: saline- flush hemodialysis with bicarbonate hemodialysate; Groups 2: hemodialysis with citrate hemodialysate without any anticoagulant; Group 3: hemodialysis with bicarbonate hemodialysate and using heparin. Every group was detected serum Ca2+ , ACT, BUN, Cr of the arterial line and the venous line and venous pressure in blood during hemodialvsis and ALT, AST, TBIL, DBIL, Na , CP , HCO3- pre and after hemodialysis. Results During the hemodialysis in group l, venous pressure lasted heightening, resulting in failur of hemodialysis for 2 hours. Hemodialysis for 2 hours in group 2 were all fin-ishedsuccessfully; moreover, ACT was extended and serum Ca2+ decreased obviously in venous tip during hemodialysis, ALT, AST, Ca + 、K+ 、Na+、C1-、HCO3-、 after the hemodialysis in group 2 were not changed (P > 0.05). Moreover, the clearance rate on dialyzer with citrate dialysate increased significantly compared with saline - flush and heparin anticoagulation. Conclusions The anticoagulation and hemodialysis effect of the new type citrate hemodialysate is satisfactory and better than that of saline- flush.

关 键 词：枸橼酸钠 血液透析液 血液透析 抗凝 

分 类 号：R459.5[医药卫生—治疗学]