局部枸橼酸抗凝与全身肝素抗凝在围术期重症患者持续静脉-静脉血液滤过中的比较研究  

Comparative studies with regional citrate anticoagulation and systemic heparin anticoagulation for continuous venovenous hemofiltration in perioperative sever patients

作　　者：周翔[1,2] 刘大为[1,2] 隆云[1,2] 张青[1,2] 何怀武[1,2] 赵华[1,2] 刘晔[1,2] 丁欣[1,2] 杜倩[1,2] 张斌[1,2] 陈焕[1,2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院转化医学中心 [2]北京协和医院重症医学科,北京100730

出　　处：《中国医刊》2014年第3期28-31,共4页Chinese Journal of Medicine

基　　金：卫生公益性行业科研专项经费项目(201202011)

摘　　要：目的研究局部枸橼酸抗凝(RCA)与全身肝素抗凝在围术期重症患者持续静脉-静脉血液滤过(CVVH)中的效果及安全性。方法回顾性分析192例进行CVVH的围术期重症患者的资料,其中全身普通肝素抗凝CVVH组(以下简称肝素组)98例,RCA-CVVH组(以下简称RCA组)94例。比较两组患者在滤器寿命、血滤终止原因及内环境影响、肝功能影响及临床出血并发症等方面的差异。结果肝素组平均滤器寿命比RCA组明显要短[(21.60±8.76)小时vs(65.75±10.17)小时],而两组导致CVVH终止的原因中由滤器凝血导致CVVH被迫终止的分别为76.5%和9.2%,因治疗达到目标选择性终止CVVH的为8.4%和63.8%,因其他治疗需要终止CVVH的为5.1%和17.0%。内环境变化方面,两组患者在代谢性碱中毒、低钙血症、高钠血症、肝脏功能变化方面差异无显著性。枸橼酸中毒在RCA组发生率仅为2.13%,临床出血情况肝素组高于RCA组(15.3%vs 5.3%)。结论 RCA-CVVH对于出血风险高的围术期重症患者来说是一种安全、有效的肾脏替代治疗方式,特别是在延长滤器寿命方面具有优势,而在内环境、肝功能损害无明显差别,与肝素抗凝相比能减少出血并发症。Objective To compare the efficacy and safety of regional citrate anticoagulation （RCA） with systemic heparin for continuous venovenous hemofiltration（CVVH） in perioperative sever patients. Method In this retrospec-tive analysis ,we studied the difference of the filter lifetime, control of acid-base status, bleeding episodes, and ad-verse effects, that is, citrate intolerance and the impacts on liver function between the heparin group and the RCA group. Result 192 patients with critical care were involved from July 2009 to November 2013 at the critical depart-ment of Peking Union Medical college Hospital ,98 in heparin group ,94 in RCA group. The filter lifetime was shorter in heparin group than RCA group[ （21.60±8.76）h vs （65.75±10.17）h,P〈0.001 ]. The incidence of the reason for circuit discontinuation among circuits in heparin group and RCA group were respectively premature clotting （76.5 % vs 9.2%, P〈 0. 001 ）, elective （ 18.4% vs 63.8%, P〈 0. 001 ）, other reasons （ 5.1% vs 17.0%, P = O. O1 ）. The acid-base status, ionic concentration, and the impacts on liver function were no significant differences between the heparin and RCA groups： The incidence of the citrate accumulation in patients treated with RCA-CVVH was only 2. 13%. The incidence of clinical bleeding was higher in heparin group than RCA group （ 15.3% vs 5.3% ,P=0. 032）. Conclusion RCA-CVVH is a safe and effective method in perioperative sever patients with a high risk of bleeding. Filter patency was excellent, acid-base status was well controlled, and clinically relevant ad-verse effects were not observed.

关 键 词：局部枸橼酸抗凝 肝素抗凝 滤器寿命 

分 类 号：R459.7[医药卫生—急诊医学]