不同抗凝方案在严重脓毒血症血小板减少患者CRRT中的应用  

Different anticoagulant techniques in severe sepsis application of CRRT treatment in patients with thrombocytopenia

作　　者：杨德淑[1] 杨平[1] 张艳[1] 文玉明[1] 

机构地区：[1]重庆市急救医疗中心重症医学科,400014

出　　处：《重庆医学》2014年第28期3724-3726,共3页Chongqing medicine

摘　　要：目的分析比较枸橼酸局部抗凝(RCA)、低分子肝素及无肝素抗凝3种方案在严重脓毒血症血小板减少患者连续性肾脏替代治疗(CRRT)中的应用效果及并发症发生情况。方法回顾性分析36例入住重症监护室行CRRT治疗的严重脓毒血症血小板减少患者,CRRT治疗分别给予RCA、低分子肝素钙及无肝素3种抗凝方案,观察3组患者CRRT治疗中凝血功能、出血情况、血小板消耗、血滤效果、滤器使用情况及15、30d病死率。结果 RCA组和无肝素组凝血功能明显优于低分子肝素钙组(P<0.05),RCA组和无肝素组凝血功能差异无统计学意义(P>0.05);RCA组出血发生率、血小板消耗明显低于无肝素组和低分子肝素钙组(P<0.05);RCA组、低分子肝素钙组滤器使用时间明显长于无肝素组(P<0.05);血滤效果及15、30d病死率3组差异无统计学意义(P>0.05)。结论严重脓毒血症血小板减少患者行CRRT应用枸橼酸局部抗凝能降低出血风险、减少对血小板的消耗、延长滤器使用寿命,保证CRRT顺利有效地完成。Objective To analyze and compare of regional citrate anticoagulation（RCA）,low molecular weight heparin and heparin-free in severe sepsis patients with thrombocytopenia CRRT treatment effect and complication of the situation.Methods Retrospective analysis of 36 patients admitted to ICU CRRT therapy of severe sepsis in patients with thrombocytopenia was made.Nine patients were given RCA,14 patients were given low-molecular-weight heparin calcium and 13 patients were given no heparin anticoagulation programme.And then observation of three groups of CRRT treatment of coagulation function in patients with platelet depletion,blood,bleeding conditions,filter effects,filter usage time,and 15-day,30-day mortality were made.Results In RCA group and heparin-free group,coagulation blood features was significantly superior to low-molecular liver pigment calcium group（P〈0.05）,there was no significant difference（P〉0.05）between RCA group and heparin-free group coagulation in blood features.Bleeding rate and platelet consumption in RCA group were significantly lower than that in heparin-free group and low molecular liver pigment group（P〈0.05）.Filter usage life in RCA group and low molecular liver pigment group was obviously longer than that in heparin-free group（P〈0.05）.There was no significant difference in filter effect,15 days,30day fatality rate among the three groups（P〉0.05）.Conclusion Severe sepsis in patients with thrombocytopenia in CRRT applications of regional citrate anticoagulation could reduce the risk of hemorrhage,reduced platelet consumption and longer filter usage time.

关 键 词：毒血症 血小板减少 肾替代疗法 抗凝药 

分 类 号：R459.7[医药卫生—急诊医学]