枸橼酸钠溶液抗凝法对血液透析患者的影响  

Effects of Sodium Citrate Solution on Hemodialysis Patients

作　　者：朱蕊[1] 陈静[1] 戎殳[1] 张斌[1] 王建新 

机构地区：[1]第二军医大学长征医院肾内科,上海200003 [2]四川省巴中市巴州区人民医院肾内科,四川巴中635000

出　　处：《解放军护理杂志》2011年第23期11-13,25,共4页Nursing Journal of Chinese People's Liberation Army

摘　　要：目的探讨枸橼酸钠溶液抗凝法对血液透析患者的影响。方法选择2004年1月至2010年8月在第二军医大学长征医院肾内科住院的围术期维持性血液透析患者90例,按随机数字表法分成两组:枸橼酸钠组(45例,169例次)和无抗凝剂组(45例,157例次)。枸橼酸钠组患者采用30%的枸橼酸钠溶液进行血透抗凝,无抗凝剂组患者采用无抗凝剂透析。观察两组患者透析器及管路凝血情况、检测透析前后部分凝血活酶时间(activated partial thromboplastin time,APTT)、患者出血情况、尿素氮(blood urea nitrogen,BUN)及血肌酐(serum creatinine,SCr)浓度、血电解质浓度,测定尿素清除率(KT/V),并观察不良反应的发生情况。结果无抗凝剂组体外循环管路凝血率明显高于枸橼酸钠组(P<0.05)。血透过程中枸橼酸钠组患者透析过程中体外APTT的差异有统计学意义(P<0.05)。透析后两组患者血BUN及Scr值均较透析前明显下降(P<0.05),透析后枸橼酸钠组较无抗凝剂组BUN及SCr值明显降低(P<0.05),血HCO3-明显升高(P<0.05),血离子钙水平较透析前降低(P<0.05)。两组患者KT/V值的差异有统计学意义(P<0.05)。枸橼酸纳组9例次(5.3%)出现唇周及四肢麻木症状,经调整枸橼酸钠速度及静脉补充钙剂后症状消失。结论作为围术期血液透析患者抗凝方式,局部枸橼酸钠溶液抗凝法较之无抗凝剂法抗凝效果显著,安全性好,护理方便。Objective To observe the effect of sodium citrate solution anticoagulation on patients with hemodialysis. Methods From January 2004 to August 2010, 90 perioperative maintenance hemodialysis patients in the hospital were randomly divided into two groups： sodium citrate group （45 patients,169 cases） using 30% sodium citrate anticoagulant hemodialysis, and non--anticoagulation group （45 patients, 157 cases） using anticoagulant-free dialysis method. The clotting of dialyzers and lines of patients was observed. The activated partial thromboplastin time （APTT） bleeding, blood urea nitroger （BUN）, serum creatinine（SCr） electrolyte concentration and ure clearan（KT/V） before and after dialysis were detected. Results The coagulation rate in vitro was significantly higher in non-- anticoagulation group than sodium citrate group（P〈0.05）. Significant difference was also detected on the APTT in vitro during hemodialysis in the sodium citrate group （P〈0.05）. After hemodialysis, the values of BUN and Scr were significantly lower in both groups then before （P〈0.05） ;the values of BUN and Scr were significantly lower in the so- dium citrate group than the non--anticoagulation group（P〈0.05）;the value of blood HCO;- was signifi- cantly increased （P〈0.05） but the blood ionized calcium levels were lower than that before predialysis （P〈0.05）. There was significant difference on the KT/V values between the two groups（P〈0.05）. Nine cases （5.3 %） of sodium citrate group developed numbness of lips and limbs, which disappeared after ad- justing the rate of sodium citrate and intravenous calcium supplement. Conclusion As an approach of peri- operative anticoagulation in hemodialysis patients,the local sodium citrate solution provides a more effec- tive,convenient and safer treatment than non-anticoagulation group.

关 键 词：枸橼酸钠 抗凝 血液透析 围术期 

分 类 号：R692.5[医药卫生—泌尿科学]