枸橼酸钠置换液在血液滤过中的抗凝效果评估  

Anti-coagulative Effect of Sodium Citrate Substitution Fluid in Hemofiltration

作　　者：罗冰[1] 熊明媚[1] 周嘉敏[1] 李仕成[1] 唐新兴[1] 黄东健[1] 

机构地区：[1]广州医学院第三附属医院,广州510150

出　　处：《热带医学杂志》2009年第8期908-910,907,共4页Journal of Tropical Medicine

基　　金：广东省科研计划项目(No.2008B030301248)

摘　　要：目的评估枸橼酸钠置换液在血液滤过中的抗凝效果。方法随机对照的实验研究,每组健康犬6只。枸橼酸钠组:配制含1.5 mmol/L枸橼酸钠抗凝剂的置换液,在血滤管路静脉端持续补钙对抗枸椽酸根;肝素组:使用低分子肝素(20 U/kg.h)持续泵入的抗凝方法。分别对急性肾功能衰竭的动物行血液滤过治疗,血流量为50 ml/min,置换液速度为500 ml/h。观察使用枸橼酸钠置换液后及补钙后血滤管道的凝血功能(PT、PT%、PT/R、PT INR、APTT、AT3%及Fbg等)的变化,记录血滤管路使用时间,以及血液滤过结束时的血清肌酐、尿素、电解质、酸碱平衡,血滤器前、以及体内凝血功能指标的变化。结果血液滤过治疗过程中,使用枸橼酸钠置换液后血滤管道中血液的凝血指标(PT、PT%、PT INR、APTT)延长,补钙后恢复正常水平,体内静脉血的凝血指标均恢复正常范围内;两组均未有血滤管路和血滤器堵塞现象,实验犬的血浆电解质、酸碱平衡、肌酐、尿素等结果两组无明显差异(P<0.01),肝素组动物体内的部分凝血指标(PT、PT INR、APTT)延长(P<0.01)。结论经研究配制后的枸橼酸钠置换液应用血液滤过治疗时,通过血滤器时有良好的抗凝效果,而且对体内凝血功能及内环境无不良影响。Objective To investigate the anti-coagulative effect of sodium citrate substitution fluid in hemofihration. Method 12 normal healthy outbreed dogs were randomly divided into two groups： Dogs in the treatment group were continuously supplied with sodium citrate substitution calcium glyconate （1.5 mmol/L） and dogs in the control group were treated with heparin （20 U/kg·h）. Hemofihration was performed with the blood flow of 50ml/min and the replacement speed of 500ml/h. Blood gas analysis, serum creatinine, blood urea nitrogen, electrolyte, prothrombin time （PT）, PT%, PT/R, PT INR, activated partial thromboplastin time （APTT）, AT3%, thromboplastin time （TT） and Fbg at pre-dialysis, and coagulation functions before hemofihration were recorded. Result During hemofihration, sodium citrate substitution fluid was found to significantly prolong PT, PT%, PT INR and APTF, and the values were restored after supplemented with calcium. The coagulation indexes were also restored t the normal values. Clotting was not observed in these 2 groups of animals. Moreover, serum creatinine and urea clearance rate were similar in both experimental and control animals （P〈 0.01）. Compared with Treatment group, plasma PT, PT INR and APTT in the control animals were significantly decrease, Conclusion Sodium citrate substitution fluid is an ideal anticoagulant for hemofiltration.

关 键 词：枸橼酸钠 置换液 血液滤过 

分 类 号：R457.1[医药卫生—治疗学]