常规透析浓缩液条件下血液透析局部枸橼酸抗凝研究  

Study on the Anticogulation of Regional Citrate in Hemodialysis Under Conventional Dialysis Concentrated Solution

作　　者：陈立平[1] 黄明霞[1] 宋加荣[1] 黄忠华[1] 彭琳琳[1] 宁建平[1] 

机构地区：[1]中南大学湘雅医院肾内科,湖南长沙410008

出　　处：《医学临床研究》2011年第1期50-52,共3页Journal of Clinical Research

摘　　要：【目的】研究局部枸橼酸抗凝（RCA）在常规透析浓缩液条件下利用透析机的“可调钠”功能在血液透析中的应用，以期摸索出一套操作简便切实可行的RCA方法。【方法】选择30例患者分为两组：局部枸橼酸抗凝组（RCA组）15例，行血液净化30例次；对照组（肝素组）15例，行小剂量肝素血液净化30例次。监测全血活化凝血时间（ACT）；观察体外循环凝血情况如滤器血管路凝血情况及患者临床出血情况；监测血清pH值、游离钙（iCa^2＋）、血钠离子（Na^＋）、碳酸氢根（HCO3^-）浓度；监测血尿素（Urea）、血清肌酐（SCr）并计算尿素清除率（URR）等。【结果】①透析2h、4h时滤器前采血与透前比较：RCA组ACT无明显变化（P〉0．05），而肝素组ACT明显延长（P〈O．05）；滤器后采血与透前比较：两组透后ACT均延长（P〈0．05）；②透析2h、4h时滤器后采血与透前比较：RCA组iCa浓度降低（P〈0．01），其与ACT值呈高度负相关（r=0．79、r=0．83），肝素组iCa^2＋浓度无明显变化；③透析后两组pH、HCO3^-、血钠均在正常范围；透析4h两组SCr下降率分别为57．83％、58．61％，URR为67．52％、69．23％。【结论】改良后的常规透析浓缩液条件下局部RCA抗凝操作简便且体外抗凝效果肯定、安全，不影响治疗效率；iCa^2＋可替代ACT作为凝血监测指标。[Objective] To investigate the application of regional citrate anticoagulation（RCA） under conventional dialysis concentrated solution in adjustable sodium hemodialysis in order to explore a simple and feasible method of RCA. [Methods] Thirty patients were divided into RCA group（ n =15） and heparin group（ n = 15）. Thirty cases in RCA group underwent blood purification. Thirty cases in heparin group underwent blood purification with low doses of heparin. The activated coagulation time（ACT） in whole blood was monitored. The coagulation in extracorporeal circulation such as the coagulation of filter vessel channel and the clinical bleeding of the patients were observed. Serum pH, free calcium（iCa24 ）, serum sodium（Na^＋ ） and bicarbonate （HCO3^- ） concentration were observed. Blood urea（Urea） and serum creatinine（＇SCr） were monitored, and urea clearance rate（URR） was calculated. [Results] When blood collection before filtration at 2h and 4h of dialysis was compared with that before dialysis, there was no obvious change of ACT in RCA group（ P 〉0.05）, but the ACT in heparin group was significantly prolonged（ P 〈0.05）. When blood collection after filtration was compared with that before dialysis, the ACT in both groups were prolonged（ P 〈0.05）. When blood collection after filtration at 2h and 4h of dialysis was compared with before dialysis, the iCa^＋ concentration in RCA decreased（ P 〈0.01） and was negatively correlated with ACT（r=0.79, r=0.83）, but iCa in heparin group showed no obvious change. After dialysis, the pH, HCO3^- and Na^＋ in both groups were within the normal range. The rate of the decrease of SCr in both groups at 4h of dialysis was 57.83% and 58.61%, respectively. The URR in both groups was 67.52% and 69.23%, respectively. [Conclusion] RCA under modifled conventional dialysis concentrated solution is simple to operate, and its anticoagulation effect is certain and safe. it does not affect the therapeutic efficacy. The iCa ^＋ can

关 键 词：血液透析 柠檬酸盐类 

分 类 号：R459.5[医药卫生—治疗学]