局部枸橼酸抗凝在活动性出血及高危出血倾向患者血液透析中的应用  

Regional Citrate Anticoagulation Technique for Hemodialysis in Patients at High Risk of Bleeding

作　　者：何永成[1] 丁小强[1] 钟一红 宦金星[1] 袁敏[1] 陈小波[2] 

机构地区：[1]上海医科大学中山医院肾内科,200032 [2]兰州军区乌鲁木齐总医院心肾科,830000

出　　处：《中国临床医学杂志》2000年第2期187-188,共2页

摘　　要：目的：进一步探讨局部枸橼酸抗凝（ＲＣＡ）技术在高危出血倾向患者尤其是活动性出血患者血液透析中应用的安全性及实施注意事项。方法：４６． ７％（１．６ ｍｏｌ／Ｌ）的枸橼酸钠由透析器动脉端滴注，含钙（１．７５ ｍｍｏｌ／Ｌ）碳酸氢盐透析液及空心纤维透析器。观察ＲＣＡ的抗凝效果及可能的并发症，主要是出血及低钙血症等。结果：３８例活动性出血及高危出血倾向的急、慢性肾衰患者，共行１１５例次ＲＣＡ透析，无引起或加重出血者，但有５例次伴严重代谢性酸中毒患者发生低钙血症表现。结论：ＲＣＡ血液透析适用于活动性出血及高危出血倾向的患者。低钙血症是其主要的并发症。Objective: To observe the safety of the hemodialysis with regional citrate anticoagulation (RCA) in patients at high risk of bleeding. Methods: 46. 7 % (1. 6 mol/L) trisodium citrate solution was infused at arterial site. The standard calcium - containing (1. 75 mmol/L) bicarbonate dialysate and hollow fiber capillary dialyzer were used. Results: 115 hemodialysis periods were performed successfully with RCA technique in 38 high bleeding risk patients. No instance bleeding was observed, hypocalcemia were observed in 5 patients who suffered serious metabolic acidosis. Conclusion: Regional citrate anticoagulation technique is a safe method which can be performed in patients at active bleeding and high risk of bleeding. The main complication is hypocalcemia.

关 键 词：枸橼酸钠 血液透析 活动性出血 高危出血 

分 类 号：R442.7[医药卫生—诊断学] R459.5[医药卫生—临床医学]